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Joseph ML, Williams M, Reinke K, Bair H, Chae S, Hanrahan K, St Marie B, Jenkins P, Albert NM, Gullatte MM, Rogers DM, Swan BA, Holden T, Woods E, DeGuzman PB, DeGennaro G, Marshall D, Hein M, Perkhounkova Y, Huber DL. Development and Testing of the Relational and Structural Components of Innovativeness Across Academia and Practice for Healthcare Progress Scale. J Nurs Adm 2024; 54:260-269. [PMID: 38630941 DOI: 10.1097/nna.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Using data from 5 academic-practice sites across the United States, researchers developed and validated a scale to measure conditions that enable healthcare innovations. BACKGROUND Academic-practice partnerships are a catalyst for innovation and healthcare development. However, limited theoretically grounded evidence exists to provide strategic direction for healthcare innovation across practice and academia. METHODS Phase 1 of the analytical strategy involved scale development using 16 subject matter experts. Phase 2 involved pilot testing the scale. RESULTS The final Innovativeness Across Academia and Practice for Healthcare Progress Scale (IA-APHPS) consisted of 7 domains: 3 relational domains, 2 structural domains, and 2 impact domains. The confirmatory factor analysis model fits well with a comparative fit index of 0.92 and a root-mean-square error of approximation of 0.06 (n = 477). CONCLUSION As the 1st validated scale of healthcare innovation, the IA-APHPS allows nurses to use a diagnostic tool to facilitate innovative processes and outputs across academic-practice partnerships.
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Affiliation(s)
- M Lindell Joseph
- Author Affiliations: Clinical Professor and Distinguished Scholar in Nursing, and Director of DNP & MSN Health Systems: Administration/Executive Leadership Programs (Dr Joseph), College of Nursing, The University of Iowa; Henry B. Tippie Faculty Research Fellow in Entrepreneurship and Associate Professor of Management and Entrepreneurship (Dr Williams), Tippie College of Business; PhD Student (Reinke), Management and Entrepreneurship Department, Tippie College of Business; Associate Director and Associate Clinical Professor (Dr Bair); and DNP in Anesthesia Nursing Program and Assistant Professor (Dr Chae), College of Nursing, The University of Iowa; Director, Nursing Research and Evidence-Based Practice (Dr Hanrahan), University of Iowa Hospitals and Clinics; and Associate Professor (Dr St. Marie), College of Nursing, The University of Iowa, Iowa City; Associate Dean for Academic Affairs (Dr Jenkins), University of Arizona, Tucson; Associate Chief Nursing Officer (Dr Albert), Research and Innovation, Zielony Nursing Institute; Clinical Nurse Specialist (Dr Albert), George M. and Linda H. Kaufman Center for Heart Failure Treatment and Recovery; and Heart, Vascular & Thoracic Institute and Consultive Staff (Dr Albert), Lerner Research Institute, Cleveland Clinic, Ohio; Corporate Director (Dr Gullatte), Nursing Research and Evidence Based Practice, Emory Healthcare; Adjunct Faculty (Dr Gullatte), Nell Hodgson Woodruff School of Nursing, Emory University; Nurse Scientist (Dr Rogers), DeKalb Operating Unit (DOU), Emory Healthcare; Senior Instructor (Dr Rogers), Nell Hodgson Woodruff School of Nursing, Emory University; and Clinical Track Associate Professor, Dean and Vice President for Academic Practice Partnerships, Executive Director for the Emory Nursing Learning Center and Nell Hodgson Woodruff School of Nursing, and Co-director of the Woodruff Health Sciences Center Interprofessional Education and Clinical Practice Office (Dr Swan), Emory University, Atlanta; Lead Advanced Practice Provider (Dr Holden), Emory Johns Creek Hospital, Johns Creek; and Magnet® Program Director for Emory Orthopedics and Spine Hospital, and Assistant Clinical Professor (Dr Woods), Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia; Nurse Scientist (Dr DeGuzman), University of Virginia Health, Charlottesville; Professor, Academic Director of Clinical Partnerships, and Assistant Department Chair of Acute and Specialty Care (Dr DeGennaro), University of Virginia School of Nursing, Charlottesville; Senior Vice President, Chief Nursing Executive, and James R. Klinenberg, MD, and Lynn Klinenberg Linkin Chair in Nursing in Honor of Linda Burnes Bolton (Dr Marshall), Cedars-Sinai, Los Angeles, California; and Data Manager (Hein) and Statistician Manager (Dr Perkhounkova), Office for Nursing Research and Scholarship, College of Nursing; and Tenured Full Professor Emeritus (Dr Huber), College of Nursing and College of Public Health, The University of Iowa, Iowa City
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Shoji S, Kaltenbach LA, Granger BB, Fonarow GC, Al-Khalidi H, Albert NM, Butler J, Allen LA, Michael Felker G, Harrison RW, Fudim M, Nelson AJ, Granger CB, Hernandez AF, DeVore AD. Remote Follow-up in a Heart Failure Pragmatic Trial: Insights From the CONNECT-HF. J Card Fail 2024:S1071-9164(24)00109-X. [PMID: 38599459 DOI: 10.1016/j.cardfail.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Randomized controlled trials typically require study-specific visits, which can burden participants and sites. Remote follow-up, such as centralized call centers for participant-reported or site-reported, holds promise for reducing costs and enhancing the pragmatism of trials. In this secondary analysis of the CONNECT-HF trial, we aimed to evaluate the completeness and validity of the remote follow-up process. METHODS AND RESULTS CONNECT-HF evaluated the effect of a post-discharge quality improvement intervention for heart failure compared to usual care for up to 1 year. Suspected events were reported either by participants or healthcare proxies through a centralized call center, or by sites through medical record queries. When potential hospitalization events were suspected, additional medical records were collected and adjudicated. Among 5,942 potential hospitalizations, 18% were only participant-reported, 28% were reported by both participants and sites, and 50% were only site-reported. Concordance rates between the participant/site reports and adjudication for hospitalization were high: 87% participant-reported, 86% both, and 86% site-reported. Rates of adjudicated heart failure hospitalization events among adjudicated all-cause hospitalization were lower but also consistent: 45% participant-reported, 50% both, and 50% site-reported. CONCLUSIONS Participant-only and site-only reports missed a substantial number of hospitalization events. We observed similar concordance between participant/site reports and adjudication for hospitalizations. Combining participant-reported and site-reported outcomes data are important to effectively capture and validate hospitalizations within pragmatic heart failure trials.
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Affiliation(s)
- Satoshi Shoji
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Gregg C Fonarow
- Division of Cardiology, Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Nancy M Albert
- Associate Chief of Nursing, Research and Innovation- Nursing Institute and Clinical Nurse Specialist- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland OH
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - G Michael Felker
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Robert W Harrison
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC; Department of Cardiology, University of Wroclaw, Wroclaw, Poland
| | - Adam J Nelson
- Duke Clinical Research Institute, Durham, NC; Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia
| | - Christopher B Granger
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC.
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Martyn T, Saef J, Bansal A, Martinez KA, Block-Beach H, Hohman J, Kapadia SR, Desai MY, Estep JD, Albert NM, Starling RC, Tang WHW. Patient and Provider Factors Associated With Initiating Sodium-Glucose Cotransporter-2 Inhibitors (SGTL2is) Following FDA Approval for Heart Failure With Preserved and Mildly Reduced Ejection Fraction. J Card Fail 2024; 30:630-632. [PMID: 38367905 DOI: 10.1016/j.cardfail.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Trejeeve Martyn
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio.
| | - Joshua Saef
- Joe DiMaggio Children's Hospital Heart Institute and Memorial Cardiac and Vascular Institute, Hollywood, Florida
| | - Agam Bansal
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio
| | - Kathryn A Martinez
- Primary Care Institute, Cleveland Clinic, Cleveland, Ohio; Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
| | | | - Jessica Hohman
- Primary Care Institute, Cleveland Clinic, Cleveland, Ohio; Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio
| | | | - Nancy M Albert
- Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio; Nursing Institute, Cleveland Clinic, Cleveland, Ohio
| | - Randall C Starling
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio; Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio
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Kerrissey M, Satterstrom P, Pae J, Albert NM. Overcoming walls and voids: Responsive practices that enable frontline workers to feel heard. Health Care Manage Rev 2024; 49:116-126. [PMID: 38345339 DOI: 10.1097/hmr.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND There is increasing recognition that beyond frontline workers' ability to speak up, their feeling heard is also vital, both for improving work processes and reducing burnout. However, little is known about the conditions under which frontline workers feel heard. PURPOSE This inductive qualitative study identifies barriers and facilitators to feeling heard among nurses in hospitals. METHODOLOGY We conducted in-depth semistructured interviews with registered nurses, nurse managers, and nurse practitioners across four hospitals ( N = 24) in a U.S. health system between July 2021 and March 2022. We coded with the aim of developing new theory, generating initial codes by studying fragments of data (lines and segments), examining and refining codes across transcripts, and finally engaging in focused coding across all data collected. FINDINGS Frontline nurses who spoke up confronted two types of challenges that prevented feeling heard: (a) walls, which describe organizational barriers that lead ideas to be rejected outright (e.g., empty solicitation), and (b) voids, which describe organizational gaps that lead ideas to be lost in the system (e.g., structural mazes). We identified categories of responsive practices that promoted feeling heard over walls (boundary framing, unscripting, priority enhancing) and voids (procedural transparency, identifying a navigator). These practices appeared more effective when conducted collectively over time. CONCLUSION Both walls and voids can prevent frontline workers from feeling heard, and these barriers may call for distinct managerial practices to address them. Future efforts to measure responsive practices and explore them in broader samples are needed. PRACTICE IMPLICATIONS Encouraging responsive practices may help ensure that frontline health care workers feel heard.
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Peacock WF, Dhand A, Albert NM, Shahid Z, Luk A, Vollman K, Schoppelrey RB, Cadwell C, Dadwal S, Amin AN, Torriani FJ. Stethoscope barriers narrative review; It's time for a strategy unfriendly to multi-drug resistant organisms (MDROs). J Infect Public Health 2024; 17:1001-1006. [PMID: 38636310 DOI: 10.1016/j.jiph.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
The current standard of stethoscope hygiene doesn't eliminate the transmission of harmful pathogens, including multi-drug resistant organisms (MDROs). In the era of the increasing prevalence of MDRO infections, the use of new systems providing touch free barriers may improve patient safety versus traditional stethoscope cleaning practices with chemical agents. Our purpose was to provide a narrative literature review regarding barriers as an improvement over the current standard of care for stethoscope hygiene. Searching PubMed, articles were identified if they were in English and published after 1990, using the search term "stethoscope barrier", or if they were from a previously published stethoscope hygiene article using "author's name + stethoscope". Included articles evaluated or discussed stethoscope barriers. Of 28 manuscripts identified, 15 met the inclusion criteria. Barriers were considered superior to alternatives if they were single use, disposable, applied in a touch free fashion, were impervious to pathogens, provided an aseptic patient contact, and were acoustically invisible. Use of a practitioner's personal stethoscope with a disposable diaphragm barrier should be recommended as a new standard of care as this represents an improvement in patient safety and patient experience when compared to the disposable stethoscope or isopropyl alcohol stethoscope diaphragm cleaning.
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Affiliation(s)
| | | | | | - Zainab Shahid
- Memorial Sloan Kettering Cancer Center, United States
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Diamond JE, Kaltenbach LA, Granger BB, Fonarow GC, Al-Khalidi HR, Albert NM, Butler J, Allen LA, Lanfear DE, Thibodeau JT, Granger CB, Hernandez AF, Ariely D, DeVore AD. Access to Mobile Health Interventions Among Patients Hospitalized With Heart Failure: Insights Into the Digital Divide From the CONNECT-HF mHealth Substudy. Circ Heart Fail 2024; 17:e011140. [PMID: 38205653 DOI: 10.1161/circheartfailure.123.011140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Affiliation(s)
| | - Lisa A Kaltenbach
- Duke Clinical Research Institute, Durham, NC (L.A.K., A.F.H., A.D.D.)
| | | | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.)
| | - Hussein R Al-Khalidi
- Department of Biostatistics and Bioinformatics (H.R.A.-K.), Duke University, Durham, NC
| | - Nancy M Albert
- Office of Nursing Research and Innovation, Cleveland Clinic Health System, Clinical Nurse Specialist-Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular & Thoracic Institute, Clinic Main Campus, OH (N.M.A.)
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX (J.B.)
- University of Mississippi, Jackson (J.B.)
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora (L.A.A.)
| | - David E Lanfear
- Division of Cardiology, Department of Medicine, Henry Ford Hospital, Detroit, MI (D.E.L.)
| | - Jennifer T Thibodeau
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas (J.T.T.)
| | - Christopher B Granger
- Division of Cardiology and Department of Medicine, Duke University School of Medicine, Durham, NC (C.B.G., A.F.H., A.D.D.)
| | - Adrian F Hernandez
- Division of Cardiology and Department of Medicine, Duke University School of Medicine, Durham, NC (C.B.G., A.F.H., A.D.D.)
- Duke Clinical Research Institute, Durham, NC (L.A.K., A.F.H., A.D.D.)
| | - Dan Ariely
- Center for Advanced Hindsight (D.A.), Duke University, Durham, NC
| | - Adam D DeVore
- Division of Cardiology and Department of Medicine, Duke University School of Medicine, Durham, NC (C.B.G., A.F.H., A.D.D.)
- Duke Clinical Research Institute, Durham, NC (L.A.K., A.F.H., A.D.D.)
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Morley G, Copley DJ, Field RB, Zelinsky M, Albert NM. A divided community: A descriptive qualitative study of the impact of the COVID-19 pandemic on nurses and their relationships. J Adv Nurs 2023; 79:4635-4647. [PMID: 37358047 DOI: 10.1111/jan.15747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/16/2023] [Accepted: 06/10/2023] [Indexed: 06/27/2023]
Abstract
AIMS To identify the personal and professional impact of the COVID-19 pandemic on clinical nurses with regard to personal and workplace safety, personal and professional relationships and perceptions of their team, organization and community, and to understand lessons learned to inform future responses to pandemics or global emergencies. DESIGN Qualitative, descriptive free-text surveys, informed by appreciative inquiry. METHODS Nurses working in adult COVID- and non-COVID cohort medical-surgical and intensive care units, outpatient cancer and general surgery centres were invited to participate. Data were collected between April and October 2021 and analysed using summative content analysis. RESULTS In total, 77 participants completed free-text surveys. Five themes were identified: (1) Constraints on nursing: barriers in communication and diminished patient safety and quality of care; (2) Navigating uncertainty: the emotional toll of the pandemic; (3) Team solidarity, renewed appreciation and reaffirming purpose in nursing work; (4) Enhanced trust versus feeling expendable; and (5) Increased isolation and polarization within communities. Nurses described a perceived negative impact on a number of their relationships, including with patients, employer and community. They described a huge emotional toll that included feelings of isolation and polarization. While some nurses described feeling supported by their team and employer, others described feeling expendable. CONCLUSION Nurses' responses provided insights into negative emotional experiences during the pandemic due to heightened uncertainty and fear, and also the importance of support received from peers, colleagues and their employer. Nurses experienced feelings of isolation and polarization within their communities. The varied responses reflect the importance of societal solidarity when faced with global emergencies, and the need for nurses to feel valued by their patients and employer. IMPACT Effective responses to public health emergencies require individuals and communities to work together to achieve collective goals. Efforts to retain nurses are critical during global emergencies. PATIENT OR PUBLIC CONTRIBUTION No patient and public involvement.
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Affiliation(s)
- Georgina Morley
- Center for Bioethics, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dianna Jo Copley
- Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic, Cleveland, Ohio, USA
- Nursing Ethics Faculty Fellow, Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rosemary B Field
- Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic Marymount Hospital, Garfield Heights, Ohio, USA
| | - Megan Zelinsky
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nancy M Albert
- Office of Nursing Research and Innovation, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic Health System, Cleveland, Ohio, USA
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Harrington J, Sun JL, Fonarow GC, Heitner SB, Divanji PH, Allen LA, Alhanti B, Yancy CW, Albert NM, DeVore AD, Felker GM, Greene SJ. Potential Applicability of Omecamtiv Mecarbil to Patients Hospitalized for Worsening Heart Failure. Am J Cardiol 2023; 205:524-526. [PMID: 37666729 DOI: 10.1016/j.amjcard.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/29/2023] [Accepted: 08/05/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Josephine Harrington
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Jie-Lena Sun
- Duke Clinical Research Institute, Durham, North Carolina
| | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles Medical Center, Los Angeles, California
| | | | | | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Aurora, Colorado
| | - Brooke Alhanti
- Duke Clinical Research Institute, Durham, North Carolina
| | - Clyde W Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nancy M Albert
- Nursing Institute; George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio
| | - Adam D DeVore
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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Ding Q, Spatz ES, Bena JF, Morrison SL, Levay M, Lin H, Grey M, Edwards NE, Isaacs D, West L, Combs P, Albert NM. Association of SGLT-2 Inhibitors With Treatment Satisfaction and Diabetes-Specific and General Health Status in Adults With Cardiovascular Disease and Type 2 Diabetes. J Am Heart Assoc 2023; 12:e029058. [PMID: 37655510 PMCID: PMC10547320 DOI: 10.1161/jaha.122.029058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 08/08/2023] [Indexed: 09/02/2023]
Abstract
Background It is unknown if initiation of a sodium-glucose cotransporter-2 inhibitor (SGLT-2i) is associated with changes in patient-reported health status outside of clinical trials. Methods and Results Using a prospective observational study design, adults with type 2 diabetes and cardiovascular disease were recruited from 14 US hospitals between November 2019 and December 2021 if they were new users of noninsulin antidiabetic medications. The primary outcome was change in 6-month diabetes treatment satisfaction. Secondary outcomes included diabetes-related symptom distress, diabetes-specific quality of life, and general health status for all patients and based on cardiovascular disease type. Inverse probability of treatment weight using propensity score was performed to compare outcome changes based on medication use. Of 887 patients (SGLT-2i: n=242) included in the inverse probability of treatment weight analyses, there was no difference in changes in treatment satisfaction in SGLT-2i users compared with other diabetes medication users (0.99 [95% CI, -0.14 to 2.13] versus 1.54 [1.08 to 2.00], P=0.38). Initiating an SGLT-2i versus other diabetes medications was associated with a greater reduction in ophthalmological symptoms (-3.09 [95% CI, -4.99 to -1.18] versus -0.38 [-1.54 to 0.77], P=0.018) but less improvement in hyperglycemia (1.08 [-2.63 to 4.79] versus -3.60 [-5.34 to -1.86], P=0.026). In subgroup analyses by cardiovascular disease type, SGLT-2i use was associated with a greater reduction in total diabetes symptom burden and neurological sensory symptoms in patients with heart failure. Conclusions Among patients with type 2 diabetes and cardiovascular disease, initiating an SGLT-2i was not associated with changes in diabetes treatment satisfaction, total diabetes symptoms, diabetes-specific quality of life, or general health status.
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Affiliation(s)
- Qinglan Ding
- College of Health and Human SciencesPurdue UniversityWest LafayetteINUSA
| | - Erica S. Spatz
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCTUSA
- Section of Cardiovascular Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - James F. Bena
- Quantitative Health SciencesCleveland ClinicClevelandOHUSA
| | | | - Michelle Levay
- Nursing Research & InnovationCleveland ClinicClevelandOHUSA
| | - Haiqun Lin
- Rutgers University School of NursingNewarkNJUSA
| | | | - Nancy E. Edwards
- College of Health and Human SciencesPurdue UniversityWest LafayetteINUSA
| | - Diana Isaacs
- Cleveland Clinic Endocrine Metabolic InstituteClevelandOHUSA
- Cleveland Clinic PharmacyClevelandOHUSA
| | | | - Pamela Combs
- Cleveland Clinic Endocrine Metabolic InstituteClevelandOHUSA
| | - Nancy M. Albert
- Nursing Research & InnovationCleveland ClinicClevelandOHUSA
- Nursing Institute and Heart, Vascular, & Thoracic Institute, Cleveland ClinicClevelandOHUSA
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Abstract
BACKGROUND There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard "narrow" definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. RESEARCH AIMS To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. RESEARCH DESIGN A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. PARTICIPANTS Registered nurses from four hospitals within one large healthcare system in Midwest United States. ETHICAL CONSIDERATIONS IRB approval was obtained. RESULTS 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by "other" distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. CONCLUSIONS Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed.
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Affiliation(s)
- Georgina Morley
- Nursing Ethics Program, Center for Bieothics, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic Health System, Cleveland, OH, USA
| | - James F Bena
- Quantitative Health Sciences, Cleveland Clinic Health System, Cleveland, OH, USA
| | - Shannon L Morrison
- Quantitative Health Sciences, Cleveland Clinic Health System, Cleveland, OH, USA
| | - Nancy M Albert
- Office of Nursing Research and Innovation, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic Health System, Cleveland, OH, USA
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Haywood HB, Sauer AJ, Allen LA, Albert NM, Devore AD. The Promise and Risks of mHealth in Heart Failure Care. J Card Fail 2023; 29:1298-1310. [PMID: 37479053 DOI: 10.1016/j.cardfail.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/04/2023] [Accepted: 07/01/2023] [Indexed: 07/23/2023]
Abstract
Mobile health (mHealth) is an emerging approach to health care. It involves wearable, connected technologies that facilitate patient-symptom or physiological monitoring, support clinical feedback to patients and physicians, and promote patients' education and self-care. Evolving algorithms may involve artificial intelligence and can assist in data aggregation and health care teams' interpretations. Ultimately, the goal is not merely to collect data; rather, it is to increase actionability. mHealth technology holds particular promise for patients with heart failure, especially those with frequently changing clinical status. mHealth, ideally, can identify care opportunities, anticipate clinical courses and augment providers' capacity to implement, titrate and monitor interventions safely, including evidence-based therapies. Although there have been marked advancements in the past decade, uncertainties remain for mHealth, including questions regarding optimal indications and acceptable payment models. In regard to mHealth capability, a better understanding is needed of the incremental benefit of mHealth data over usual care, the accuracy of specific mHealth data points in making clinical care decisions, and the efficiency and precision of algorithms used to dictate actions. Importantly, emerging regulations in the wake of COVID-19, and now the end of the federal public health emergency, offer both opportunity and risks to the broader adoption of mHealth-enabled services. In this review, we explore the current state of mHealth in heart failure, with particular attention to the opportunities and challenges this technology creates for patients, health care providers and other stakeholders.
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Affiliation(s)
- Hubert B Haywood
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | - Larry A Allen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH
| | - Adam D Devore
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
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12
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Harrington J, Sun JL, Fonarow GC, Heitner SB, Divanji PH, Binder G, Allen LA, Alhanti B, Yancy CW, Albert NM, DeVore AD, Felker GM, Greene SJ. Clinical Profile, Health Care Costs, and Outcomes of Patients Hospitalized for Heart Failure With Severely Reduced Ejection Fraction. J Am Heart Assoc 2023; 12:e028820. [PMID: 37158118 DOI: 10.1161/jaha.122.028820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Background Many patients with heart failure (HF) have severely reduced ejection fraction but do not meet threshold for consideration of advanced therapies (ie, stage D HF). The clinical profile and health care costs associated with these patients in US practice is not well described. Methods and Results We examined patients hospitalized for worsening chronic heart failure with reduced ejection fraction ≤40% from 2014 to 2019 in the GWTG-HF (Get With The Guidelines-Heart Failure) registry, who did not receive advanced HF therapies or have end-stage kidney disease. Patients with severely reduced EF defined as EF ≤30% were compared with those with EF 31% to 40% in terms of clinical profile and guideline-directed medical therapy. Among Medicare beneficiaries, postdischarge outcomes and health care expenditure were compared. Among 113 348 patients with EF ≤40%, 69% (78 589) had an EF ≤30%. Patients with severely reduced EF ≤30% tended to be younger and were more likely to be Black. Patients with EF ≤30% also tended to have fewer comorbidities and were more likely to be prescribed guideline-directed medical therapy ("triple therapy" 28.3% versus 18.2%, P<0.001). At 12-months postdischarge, patients with EF ≤30% had significantly higher risk of death (HR, 1.13 [95% CI, 1.08-1.18]) and HF hospitalization (HR, 1.14 [95% CI, 1.09-1.19]), with similar risk of all-cause hospitalizations. Health care expenditures were numerically higher for patients with EF ≤30% (median US$22 648 versus $21 392, P=0.11). Conclusions Among patients hospitalized for worsening chronic heart failure with reduced ejection fraction in US clinical practice, most patients have severely reduced EF ≤30%. Despite younger age and modestly higher use of guideline-directed medical therapy at discharge, patients with severely reduced EF face heightened postdischarge risk of death and HF hospitalization.
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Affiliation(s)
- Josephine Harrington
- Division of Cardiology Duke University School of Medicine Durham NC
- Duke Clinical Research Institute Durham NC USA
| | | | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center University of California Los Angeles Medical Center Los Angeles CA
| | | | | | | | - Larry A Allen
- Division of Cardiology & Colorado Cardiovascular Outcomes Research Consortium University of Colorado School of Medicine Aurora CO
| | | | - Clyde W Yancy
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago IL
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure Cleveland Clinic Cleveland OH
| | - Adam D DeVore
- Division of Cardiology Duke University School of Medicine Durham NC
- Duke Clinical Research Institute Durham NC USA
| | - G Michael Felker
- Division of Cardiology Duke University School of Medicine Durham NC
- Duke Clinical Research Institute Durham NC USA
| | - Stephen J Greene
- Division of Cardiology Duke University School of Medicine Durham NC
- Duke Clinical Research Institute Durham NC USA
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13
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Hartman JH, Bena JF, Morrison SL, Albert NM. Assessment of the Value of a Carriage System to Organize and Elevate Intravenous Tubing. J Infus Nurs 2023; 46:149-156. [PMID: 37104690 DOI: 10.1097/nan.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Caregiver/patient fall injury risks increase when medical tubing drapes on floors. The objective of this research was to examine the value of a novel carriage system that organizes and elevates medical and intravenous (IV) tubing. Using a prospective, multicenter, cohort design, value of the IV carriage system was assessed using a valid, reliable survey that provided the total score and scores of 3 involvement factors: personal relevance, attitude, and importance. The survey was scored on a 0-100 scale, and questions about tubing elevation, patient mobility, and ease of use were rated on 0-10 scales. Participants were adult and pediatric inpatient caregivers (n = 131). In adult intensive care environments (n = 61), carriage system value scores were higher in the quaternary care site compared to 4 enterprise adult intensive care sites (median [Q1, Q3]: 90.0 [69.2, 97.5] vs 72.5 [52.5, 78.3], respectively; P = .008). Compared to nurses working in adult environments (n = 58), pediatric nurses (n = 40) had higher value scores (median [Q1, Q3]: 89.2 [68.3, 97.5] vs 97.5 [85.8, 100.0], respectively; P = .007). High median score ratings (9-10) were given for tubing elevation, patient mobility, and ease of use. In conclusion, the IV carriage system was valued by nurses as an important tool in clinical practice.
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Affiliation(s)
- Jane H Hartman
- Advanced Practice Nursing (Ms Hartman) and Nursing Research and Innovation (Dr Albert), Nursing Institute, and Quantitative Health Sciences (Mr Bena and Ms Morrison), Cleveland Clinic, Cleveland, Ohio
- Jane H. Hartman, MSN, APRN, CPNP-PC, is a pediatric clinical nurse specialist in the Office of Advanced Practice Nursing, Nursing Institute, Cleveland Clinic. She received an MSN from the University of Akron (Akron, OH, 2005). Ms Hartman has been an advanced practice nurse for 17 years and a pediatric nurse for 42 years. Areas of expertise are pediatric vascular access and pediatric clinical nursing in hospital and ambulatory settings. She has 4 publications (all research articles) and 3 book chapters. Publication and research interests are in innovative products and services for pediatric patients or families, as well as those surrounding vascular access and challenging pediatric clinical situations. James F. Bena, MS, is a principal biostatistician in quantitative health sciences at the Cleveland Clinic. He received an MS in statistics from Miami University (Oxford, OH, 2000). Mr Bena has been a biostatistician for more than 20 years and at the Cleveland Clinic since 2003. He has expertise in the design and analysis of both observational and experimental research projects and has collaborated with both basic and clinical researchers. He has coauthored more than 200 publications and has served as a statistical reviewer for several medical journals. Shannon L. Morrison, MS, is a statistical programmer in quantitative health sciences at the Cleveland Clinic. She received her MS in statistics from the University of Akron (2007). Ms Morrison has been a statistical programmer at the Cleveland Clinic for 13 years and has expertise in data manipulation and cleaning, as well as SAS programming. She is listed as an author on over 40 publications, with one as first author, and has been a presenter at SAS conferences throughout the Midwestern region of the United States. Nancy M. Albert, PhD, RN, CCNS, CHFN, CCRN, NE-BC, is the associate chief nursing officer, research and innovation, Office of Research and Innovation, Nursing Institute, at the Cleveland Clinic. She received a PhD from Kent State University (Kent, OH, 2005). Dr Albert has been a research scientist for 21 years and an advanced practice nurse in advanced heart failure for 30 years. Dr Albert has expertise as a nursing leader and administrator, heart failure clinician and scientist, mentor to nurses conducting research, educator (adjunct professor at 2 universities), and has cardiology expertise (medical and surgical). Dr. Albert has over 375 publications (both research and review articles), book chapters, and 2 books. Research interests are related to biobehavioral interventions to improve clinical outcomes in adults with heart failure
| | - James F Bena
- Advanced Practice Nursing (Ms Hartman) and Nursing Research and Innovation (Dr Albert), Nursing Institute, and Quantitative Health Sciences (Mr Bena and Ms Morrison), Cleveland Clinic, Cleveland, Ohio
- Jane H. Hartman, MSN, APRN, CPNP-PC, is a pediatric clinical nurse specialist in the Office of Advanced Practice Nursing, Nursing Institute, Cleveland Clinic. She received an MSN from the University of Akron (Akron, OH, 2005). Ms Hartman has been an advanced practice nurse for 17 years and a pediatric nurse for 42 years. Areas of expertise are pediatric vascular access and pediatric clinical nursing in hospital and ambulatory settings. She has 4 publications (all research articles) and 3 book chapters. Publication and research interests are in innovative products and services for pediatric patients or families, as well as those surrounding vascular access and challenging pediatric clinical situations. James F. Bena, MS, is a principal biostatistician in quantitative health sciences at the Cleveland Clinic. He received an MS in statistics from Miami University (Oxford, OH, 2000). Mr Bena has been a biostatistician for more than 20 years and at the Cleveland Clinic since 2003. He has expertise in the design and analysis of both observational and experimental research projects and has collaborated with both basic and clinical researchers. He has coauthored more than 200 publications and has served as a statistical reviewer for several medical journals. Shannon L. Morrison, MS, is a statistical programmer in quantitative health sciences at the Cleveland Clinic. She received her MS in statistics from the University of Akron (2007). Ms Morrison has been a statistical programmer at the Cleveland Clinic for 13 years and has expertise in data manipulation and cleaning, as well as SAS programming. She is listed as an author on over 40 publications, with one as first author, and has been a presenter at SAS conferences throughout the Midwestern region of the United States. Nancy M. Albert, PhD, RN, CCNS, CHFN, CCRN, NE-BC, is the associate chief nursing officer, research and innovation, Office of Research and Innovation, Nursing Institute, at the Cleveland Clinic. She received a PhD from Kent State University (Kent, OH, 2005). Dr Albert has been a research scientist for 21 years and an advanced practice nurse in advanced heart failure for 30 years. Dr Albert has expertise as a nursing leader and administrator, heart failure clinician and scientist, mentor to nurses conducting research, educator (adjunct professor at 2 universities), and has cardiology expertise (medical and surgical). Dr. Albert has over 375 publications (both research and review articles), book chapters, and 2 books. Research interests are related to biobehavioral interventions to improve clinical outcomes in adults with heart failure
| | - Shannon L Morrison
- Advanced Practice Nursing (Ms Hartman) and Nursing Research and Innovation (Dr Albert), Nursing Institute, and Quantitative Health Sciences (Mr Bena and Ms Morrison), Cleveland Clinic, Cleveland, Ohio
- Jane H. Hartman, MSN, APRN, CPNP-PC, is a pediatric clinical nurse specialist in the Office of Advanced Practice Nursing, Nursing Institute, Cleveland Clinic. She received an MSN from the University of Akron (Akron, OH, 2005). Ms Hartman has been an advanced practice nurse for 17 years and a pediatric nurse for 42 years. Areas of expertise are pediatric vascular access and pediatric clinical nursing in hospital and ambulatory settings. She has 4 publications (all research articles) and 3 book chapters. Publication and research interests are in innovative products and services for pediatric patients or families, as well as those surrounding vascular access and challenging pediatric clinical situations. James F. Bena, MS, is a principal biostatistician in quantitative health sciences at the Cleveland Clinic. He received an MS in statistics from Miami University (Oxford, OH, 2000). Mr Bena has been a biostatistician for more than 20 years and at the Cleveland Clinic since 2003. He has expertise in the design and analysis of both observational and experimental research projects and has collaborated with both basic and clinical researchers. He has coauthored more than 200 publications and has served as a statistical reviewer for several medical journals. Shannon L. Morrison, MS, is a statistical programmer in quantitative health sciences at the Cleveland Clinic. She received her MS in statistics from the University of Akron (2007). Ms Morrison has been a statistical programmer at the Cleveland Clinic for 13 years and has expertise in data manipulation and cleaning, as well as SAS programming. She is listed as an author on over 40 publications, with one as first author, and has been a presenter at SAS conferences throughout the Midwestern region of the United States. Nancy M. Albert, PhD, RN, CCNS, CHFN, CCRN, NE-BC, is the associate chief nursing officer, research and innovation, Office of Research and Innovation, Nursing Institute, at the Cleveland Clinic. She received a PhD from Kent State University (Kent, OH, 2005). Dr Albert has been a research scientist for 21 years and an advanced practice nurse in advanced heart failure for 30 years. Dr Albert has expertise as a nursing leader and administrator, heart failure clinician and scientist, mentor to nurses conducting research, educator (adjunct professor at 2 universities), and has cardiology expertise (medical and surgical). Dr. Albert has over 375 publications (both research and review articles), book chapters, and 2 books. Research interests are related to biobehavioral interventions to improve clinical outcomes in adults with heart failure
| | - Nancy M Albert
- Advanced Practice Nursing (Ms Hartman) and Nursing Research and Innovation (Dr Albert), Nursing Institute, and Quantitative Health Sciences (Mr Bena and Ms Morrison), Cleveland Clinic, Cleveland, Ohio
- Jane H. Hartman, MSN, APRN, CPNP-PC, is a pediatric clinical nurse specialist in the Office of Advanced Practice Nursing, Nursing Institute, Cleveland Clinic. She received an MSN from the University of Akron (Akron, OH, 2005). Ms Hartman has been an advanced practice nurse for 17 years and a pediatric nurse for 42 years. Areas of expertise are pediatric vascular access and pediatric clinical nursing in hospital and ambulatory settings. She has 4 publications (all research articles) and 3 book chapters. Publication and research interests are in innovative products and services for pediatric patients or families, as well as those surrounding vascular access and challenging pediatric clinical situations. James F. Bena, MS, is a principal biostatistician in quantitative health sciences at the Cleveland Clinic. He received an MS in statistics from Miami University (Oxford, OH, 2000). Mr Bena has been a biostatistician for more than 20 years and at the Cleveland Clinic since 2003. He has expertise in the design and analysis of both observational and experimental research projects and has collaborated with both basic and clinical researchers. He has coauthored more than 200 publications and has served as a statistical reviewer for several medical journals. Shannon L. Morrison, MS, is a statistical programmer in quantitative health sciences at the Cleveland Clinic. She received her MS in statistics from the University of Akron (2007). Ms Morrison has been a statistical programmer at the Cleveland Clinic for 13 years and has expertise in data manipulation and cleaning, as well as SAS programming. She is listed as an author on over 40 publications, with one as first author, and has been a presenter at SAS conferences throughout the Midwestern region of the United States. Nancy M. Albert, PhD, RN, CCNS, CHFN, CCRN, NE-BC, is the associate chief nursing officer, research and innovation, Office of Research and Innovation, Nursing Institute, at the Cleveland Clinic. She received a PhD from Kent State University (Kent, OH, 2005). Dr Albert has been a research scientist for 21 years and an advanced practice nurse in advanced heart failure for 30 years. Dr Albert has expertise as a nursing leader and administrator, heart failure clinician and scientist, mentor to nurses conducting research, educator (adjunct professor at 2 universities), and has cardiology expertise (medical and surgical). Dr. Albert has over 375 publications (both research and review articles), book chapters, and 2 books. Research interests are related to biobehavioral interventions to improve clinical outcomes in adults with heart failure
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14
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Tsutsui H, Albert NM, Coats AJS, Anker SD, Bayes-Genis A, Butler J, Chioncel O, Defilippi CR, Drazner MH, Felker GM, Filippatos G, Fiuzat M, Ide T, Januzzi JL, Kinugawa K, Kuwahara K, Matsue Y, Mentz RJ, Metra M, Pandey A, Rosano G, Saito Y, Sakata Y, Sato N, Seferovic PM, Teerlink J, Yamamoto K, Yoshimura M. Natriuretic peptides: role in the diagnosis and management of heart failure: a scientific statement from the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America and Japanese Heart Failure Society. Eur J Heart Fail 2023; 25:616-631. [PMID: 37098791 DOI: 10.1002/ejhf.2848] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 04/27/2023] Open
Abstract
Natriuretic peptides, brain (B-type) natriuretic peptide (BNP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) are globally and most often used for the diagnosis of heart failure (HF). In addition, they can have an important complementary role in the risk stratification of its prognosis. Since the development of angiotensin receptor-neprilysin inhibitors (ARNIs), the use of natriuretic peptides as therapeutic agents has grown in importance. The present document is the result of the Trilateral Cooperation Project among the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America and the Japanese Heart Failure Society. It represents an expert consensus that aims to provide a comprehensive, up-to-date perspective on natriuretic peptides in the diagnosis and management of HF, with a focus on the following main issues: (1) history and basic research: discovery, production and cardiovascular protection; (2) diagnostic and prognostic biomarkers: acute HF, chronic HF, inclusion/endpoint in clinical trials, and natriuretic peptide-guided therapy; (3) therapeutic use: nesiritide (BNP), carperitide (ANP) and ARNIs; and (4) gaps in knowledge and future directions.
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Affiliation(s)
- Hiroyuki Tsutsui
- From the Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nancy M Albert
- Research and Innovation-Nursing Institute, Kaufman Center for Heart Failure-Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew J S Coats
- University of Warwick, Warwick, UK, and Monash University, Clayton, Australia
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin, Germany; Charite Universit atsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Spain
- Universitat Autonoma Barcelona, Spain
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- University of Mississippi, Jackson, MS, USA
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases Prof. C.C. Iliescu Bucharest, University of Medicine Carol Davila, Bucharest, Romania
| | | | - Mark H Drazner
- Clinical Chief of Cardiology, University of Texas Southwestern Medical Center, Department of Internal Medicine/Division of Cardiology, Dallas, TX, USA
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Gerasimos Filippatos
- School of Medicine of National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Mona Fiuzat
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Tomomi Ide
- From the Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School and Baim Institute for Clinical Research, Boston, MA, USA
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Marco Metra
- Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Ambarish Pandey
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
- Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Petar M Seferovic
- University of Belgrade Faculty of Medicine, Serbian Academy of Sciences and Arts, and Heart Failure Center, Belgrade University Medical Center, Belgrade, Serbia
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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15
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Tsutsui H, Albert NM, Coats AJS, Anker SD, Bayes-Genis A, Butler J, Chioncel O, Defilippi CR, Drazner MH, Felker GM, Filippatos G, Fiuzat M, Ide T, Januzzi JL, Kinugawa K, Kuwahara K, Matsue Y, Mentz RJ, Metra M, Pandey A, Rosano G, Saito Y, Sakata Y, Sato N, Seferovic PM, Teerlink J, Yamamoto K, Yoshimura M. Natriuretic Peptides: Role in the Diagnosis and Management of Heart Failure: A Scientific Statement From the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America and Japanese Heart Failure Society. J Card Fail 2023; 29:787-804. [PMID: 37117140 DOI: 10.1016/j.cardfail.2023.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 04/30/2023]
Abstract
Natriuretic peptides, brain (B-type) natriuretic peptide (BNP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) are globally and most often used for the diagnosis of heart failure (HF). In addition, they can have an important complementary role in the risk stratification of its prognosis. Since the development of angiotensin receptor neprilysin inhibitors (ARNIs), the use of natriuretic peptides as therapeutic agents has grown in importance. The present document is the result of the Trilateral Cooperation Project among the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America and the Japanese Heart Failure Society. It represents an expert consensus that aims to provide a comprehensive, up-to-date perspective on natriuretic peptides in the diagnosis and management of HF, with a focus on the following main issues: (1) history and basic research: discovery, production and cardiovascular protection; (2) diagnostic and prognostic biomarkers: acute HF, chronic HF, inclusion/endpoint in clinical trials, and natriuretic peptides-guided therapy; (3) therapeutic use: nesiritide (BNP), carperitide (ANP) and ARNIs; and (4) gaps in knowledge and future directions.
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Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Nancy M Albert
- Research and Innovation-Nursing Institute, Kaufman Center for Heart Failure-Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew J S Coats
- University of Warwick, Warwick, UK, and Monash University, Clayton, Australia
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin, Germany; Charité Universitätsmedizin Berlin, Germany; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Spain; Universitat Autonoma Barcelona, Spain
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases Prof. C.C. Iliescu Bucharest, University of Medicine Carol Davila, Bucharest, Romania
| | | | - Mark H Drazner
- Clinical Chief of Cardiology, University of Texas Southwestern Medical Center, Department of Internal Medicine/Division of Cardiology, Dallas, Texas, USA
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gerasimos Filippatos
- School of Medicine of National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Mona Fiuzat
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, Nortth Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Marco Metra
- Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Ambarish Pandey
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan; Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Petar M Seferovic
- University of Belgrade Faculty of Medicine, Serbian Academy of Sciences and Arts, and Heart Failure Center, Belgrade University Medical Center, Belgrade, Serbia
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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16
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Pierce JB, Ikeaba U, Peters AE, DeVore AD, Chiswell K, Allen LA, Albert NM, Yancy CW, Fonarow GC, Greene SJ. Quality of Care and Outcomes Among Patients Hospitalized for Heart Failure in Rural vs Urban US Hospitals: The Get With The Guidelines-Heart Failure Registry. JAMA Cardiol 2023; 8:376-385. [PMID: 36806447 PMCID: PMC9941973 DOI: 10.1001/jamacardio.2023.0241] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023]
Abstract
Importance Prior studies have suggested patients with heart failure (HF) from rural areas have worse clinical outcomes. Contemporary differences between rural and urban hospitals in quality of care and clinical outcomes for patients hospitalized for HF remain poorly understood. Objective To assess quality of care and clinical outcomes for US patients hospitalized for HF at rural vs urban hospitals. Design, Setting, and Participants This retrospective cohort study analyzed 774 419 patients hospitalized for HF across 569 sites in the Get With The Guidelines-Heart Failure (GWTG-HF) registry between January 1, 2014, and September 30, 2021. Postdischarge outcomes were assessed in a subset of 161 996 patients linked to Medicare claims. Data were analyzed from August 2022 to January 2023. Main Outcomes and Measures GWTG-HF quality measures, in-hospital mortality, length of stay, and 30-day mortality and readmission outcomes. Results This study included 19 832 patients (2.6%) and 754 587 patients (97.4%) hospitalized at 49 rural hospitals (8.6%) and 520 urban hospitals (91.4%), respectively. Of 774 419 included patients, 366 161 (47.3%) were female, and the median (IQR) age was 73 (62-83) years. Compared with patients at urban hospitals, patients at rural hospitals were older (median [IQR] age, 74 [64-84] years vs 73 [61-83] years; standardized difference, 10.63) and more likely to be non-Hispanic White (14 572 [73.5%] vs 498 950 [66.1%]; standardized difference, 34.47). In adjusted models, patients at rural hospitals were less likely to be prescribed cardiac resynchronization therapy (adjusted risk difference [aRD], -13.5%; adjusted odds ratio [aOR], 0.44; 95% CI, 0.22-0.92), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (aRD, -3.7%; aOR, 0.71; 95% CI, 0.53-0.96), and an angiotensin receptor-neprilysin inhibitor (aRD, -5.0%; aOR, 0.68; 95% CI, 0.47-0.98) at discharge. In-hospital mortality was similar between rural and urban hospitals (460 of 19 832 [2.3%] vs 20 529 of 754 587 [2.7%]; aOR, 0.86; 95% CI, 0.70-1.07). Patients at rural hospitals were less likely to have a length of stay of 4 or more days (aOR, 0.75; 95% CI, 0.67-0.85). Among Medicare beneficiaries, there were no significant differences between rural and urban hospitals in 30-day HF readmission (adjusted hazard ratio [aHR], 1.03; 95% CI, 0.90-1.19), all-cause readmission (aHR, 0.97; 95% CI, 0.91-1.04), and all-cause mortality (aHR, 1.05; 95% CI, 0.91-1.21). Conclusions and Relevance In this large contemporary cohort of US patients hospitalized for HF, care at rural hospitals was independently associated with lower use of some guideline-recommended therapies at discharge and shorter length of stay. In-hospital mortality and 30-day postdischarge outcomes were similar at rural and urban hospitals.
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Affiliation(s)
- Jacob B. Pierce
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Anthony E. Peters
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Adam D. DeVore
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Karen Chiswell
- Duke Clinical Research Institute, Durham, North Carolina
| | - Larry A. Allen
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora
| | - Nancy M. Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio
| | - Clyde W. Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA Cardiology
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles
- Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
| | - Stephen J. Greene
- Duke Clinical Research Institute, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Harrington J, Sun J, Fonarow GC, Heitner SB, Divanji P, Alhanti B, Allen LA, Yancy CW, Albert NM, DeVore A, Felker GM, Greene S. APPLICABILITY OF THE GALACTIC-HF TRIAL AND OMECAMTIV MECARBIL TO PATIENTS HOSPITALIZED FOR HEART FAILURE IN THE UNITED STATES: FROM THE GWTG-HF REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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18
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Chapman B, Kaltenbach L, Granger B, Allen LA, Albert NM, Al-Khalidi H, Granger CB, Lanfear DE, Thibodeau JT, Oliver-McNeil SM, Butler J, Felker GM, Pina IL, Fonarow GC, Hernandez AF, DeVore A. ADJUSTMENT OF GUIDELINE-DIRECTED MEDICAL THERAPY ONE YEAR POST-HEART FAILURE HOSPITALIZATION FALLS SHORT: INSIGHTS FROM THE CONNECT-HF TRIAL. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Martyn T, Saef J, Brooksbank J, Block-Beach H, Puthenpura M, Hohman J, Albert NM, Starling RC, Tang WHW. RENAL IMPAIRMENT IMPACTS PRESCRIBING OF NEWER GUIDELINE-DIRECTED MEDICAL THERAPY WELL BEFORE CLINICAL TRIAL DEFINED THRESHOLDS FOR USE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00970-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Diamond JE, Kaltenbach L, Granger B, Fonarow GC, Al-Khalidi H, Albert NM, Butler J, Allen LA, Lanfear DE, Thibodeau JT, Granger CB, Hernandez AF, DeVore A. CHARACTERIZING THE DIGITAL DIVIDE & ACCESS TO MOBILE HEALTH INTERVENTIONS IN HEART FAILURE: INSIGHTS FROM THE CONNECT-HF MHEALTH SUBSTUDY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02588-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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21
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DeWalt NC, Stahorsky KA, Sturges S, Bena JF, Morrison SL, Drobnich Sulak L, Szczepinski L, Albert NM. Simulation Versus Written Fall Prevention Education in Older Hospitalized Adults: A Randomized Controlled Study. Clin Nurs Res 2023; 32:278-287. [PMID: 35291853 DOI: 10.1177/10547738221082192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Using a randomized controlled, non-blinded, two-group design, differences in fall risk assessment, post-discharge sustainable fall risk changes, fall events and re-hospitalization were examined in 77 older adults who received a simulation (n = 36) or written (n = 41) education intervention. Between-group differences and changes in pre- versus post-fall risk assessment scores were examined using Pearson's chi-square, Wilcoxon rank sum or Fisher's exact tests (categorical variables) and two-sample t-tests (continuous variables). There were no statistically significant differences between groups in demographic characteristics. Patients who received simulation education had higher fall risk post-assessment scores than the written education group, p = .022. Change in fall risk assessment scores (post-vs.-pre; 95% confidence intervals) were higher in the simulation group compared to the written education group, 1.43 (0.37, 2.50), p = .009. At each post-discharge assessment, fall events were numerically fewer but not significantly different among simulation and education group participants. There were no statistically significant between-group differences in re-hospitalization.
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Affiliation(s)
- Nancy C DeWalt
- Cleveland Clinic Hillcrest Hospital, Mayfield Heights, OH, USA
| | | | - Susan Sturges
- Cleveland Clinic Hillcrest Hospital, Mayfield Heights, OH, USA
| | - James F Bena
- Cleveland Clinic Hillcrest Hospital, Mayfield Heights, OH, USA
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22
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Khan MS, Xu H, Fonarow GC, Lautsch D, Hilkert R, Allen LA, DeVore AD, Alhanti B, Yancy CW, Albert NM, Butler J, Greene SJ. Applicability of Vericiguat to Patients Hospitalized for Heart Failure in the United States. JACC Heart Fail 2023; 11:211-223. [PMID: 36754528 PMCID: PMC11045268 DOI: 10.1016/j.jchf.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND In January 2021, vericiguat, a soluble guanylate cyclase stimulator, was approved by the U.S. Food and Drug Administration (FDA) to reduce the risk of cardiovascular death and heart failure (HF) hospitalization among patients with a recent worsening HF event based on the VICTORIA (VerICiguaT Global Study in Subjects with Heart Failure with Reduced Ejection Fraction) trial. OBJECTIVES This study sought to leverage a contemporary U.S. registry of patients hospitalized for heart failure (HF) to characterize patients who may be candidates for vericiguat based on FDA label and the VICTORIA trial eligibility criteria. METHODS The authors studied patients hospitalized for HF with ejection fraction (EF) <45% across 525 sites in the GWTG-HF (Get With The Guidelines-Heart Failure) registry between January 2014 and December 2020. Approximate FDA label criteria (excluding estimated glomerular filtration rate [eGFR] <15 mL/min/1.73 m2, dialysis, or patients with heart transplantation or durable mechanical circulatory support) and eligibility criteria for the VICTORIA trial were applied to the GWTG-HF cohort. RESULTS Among 241,057 patients with EF <45% in the GWTG-HF registry, 221,730 (92%) could be candidates for vericiguat under the FDA label and 92,249 (38%) would have been eligible for the VICTORIA trial. The most frequent reasons for ineligibility for the FDA label were eGFR <15 mL/min/1.73 m2 (5.7%) and dialysis (1.6%). Although there were greater proportions of women and Black patients in the GWTG-HF registry, most clinical characteristics were qualitatively similar with patients enrolled in the VICTORIA trial. Among Medicare beneficiaries in the GWTG-HF registry eligible for vericiguat by either FDA label or VICTORIA trial criteria, 12-month postdischarge rates of mortality (36%-37%), HF hospitalization (33%-35%), all-cause hospitalization (64%-66%), and mean health care expenditure (U.S. $25,106-$25,428) were high. CONCLUSIONS Data from a large, contemporary U.S. registry of patients actively hospitalized for HF with EF <45% suggest that approximately 4 in 10 patients meet the criteria of the VICTORIA trial and that more than 9 in 10 patients are potential candidates for vericiguat based on the FDA label. Contemporary Medicare beneficiaries hospitalized for HF with EF <45% and eligible for vericiguat face high rates of postdischarge mortality and readmission and accrue substantial health care costs.
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Affiliation(s)
- Muhammad Shahzeb Khan
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Haolin Xu
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | | | | | - Larry A Allen
- Division of Cardiology and Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adam D DeVore
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Brooke Alhanti
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Clyde W Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
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23
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Bogner S, Bena JF, Morrison SL, Albert NM. Outcomes after implementing a heart failure diuretic pathway in an emergency department setting. Heart Lung 2023; 57:250-256. [PMID: 36332348 DOI: 10.1016/j.hrtlng.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/07/2022] [Accepted: 10/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Among patients with acute decompensated heart failure (HF), national and international loop diuretic therapy recommendations may not be followed in the emergency department (ED). OBJECTIVES To examine if loop diuretic treatment and patient disposition from the ED differed after implementing a clinical pathway based on national HF guidelines. METHODS Using an observational, pre- and post-intervention design, after clinical pathway implementation, loop diuretic medications and clinical outcomes were retrieved from medical records. Analyses included Pearson's Chi-square or Fisher's exact test, 2-sample T-test or Wilcoxon rank sum test. RESULTS Of 182 pre- and 122 post-intervention patients, mean (SD) patient age was 67.9 (13.4) years and 44.2% were Caucasian. There were no between-group differences in pre-ED visit loop diuretic prescription or dosages. More post-intervention ED patients received at least one dose of loop diuretic (94.3% vs. 81.9%, p = 0.010); however, the overall dose (mg) across groups was lower than the home dose and was not based on national guideline expectations. Doses from home to ED decreased less in the post-intervention group for patients who received doses at both time points and for all patients: p = 0.047 and p = 0.048, respectively. There was no between-group differences in short-stay unit (SSU) admissions, p = 0.33. Post-intervention patients were hospitalized from the ED (p = 0.050) and SSU (p = 0.005) less often than pre-intervention patients. Discharge to home from the ED or SSU increased in the post-intervention period; 16.4% vs. 4.9%, p = 0.009. CONCLUSIONS Among ED patients treated for HF, diuretic dosing was non-optimized. New interventions are needed to enhance adherence to national guidelines.
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Affiliation(s)
- Samantha Bogner
- Nurse Practitioner- Emergency Services Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - James F Bena
- Biostatistician, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Shannon L Morrison
- Statistical Programmer, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Nancy M Albert
- Associate Chief Nursing Officer- Research and Innovation, Nursing Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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24
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Zito A, Briskin I, Bena JF, Albert NM. Effect of a Medication Disposal Pouch versus Usual Care on Post Discharge Disposal of Unused Opioids: A Randomized Controlled Trial. J Perianesth Nurs 2022; 37:842-847. [PMID: 35382960 DOI: 10.1016/j.jopan.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine frequency of disposal of unused opioids after surgical procedures based on medication disposal pouch use or usual care, and patient factors associated with disposal. DESIGN Two-group experimental design and convenience sample. METHODS Same-day surgery adults who received opioid orders were randomized to usual care or usual care plus a medication disposal pouch for opioid disposal. Opioid disposal and pain characteristics were collected by telephone at 30±10 days post discharge. Other data were abstracted from a hospital database. Data were compared using Kruskal-Wallis, Pearson's Chi-Square and Fisher's exact tests. Logistic regression models were built to identify predictors of disposal of unused opioids. FINDINGS Of 221 adults, mean age was 58.5 years and 50.2% were female. Overall, 121 received medication disposal pouches and 100 received usual care. Among those with a filled prescription, there was no between-group difference in the number of patients who used all of their opioid medication (disposal pouch group, 29.5%; usual care group, 21.7%). Of 74 disposal pouch and 65 usual care patients who did not use all opioid medications, 23.0% and 13.8%, respectively, disposed of opioids, and of the 23.0% of patients who disposed of medications in the disposal pouch group, 94.1% used the medication disposal pouch. After controlling for 7 factors, the odds of disposal of unused opioids increased among patients who received the intervention, had lower pain scores on the worst day of postoperative pain, and had a history of renal diagnoses (versus those with gastrointestinal diagnoses). CONCLUSIONS Although opioid medication disposal rates were higher in the medication disposal pouch group; overall rates of disposal of unused opioid medications were low. More research is needed to learn important factors and methods associated with opioid disposal.
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Affiliation(s)
- Antoinette Zito
- Cleveland Clinic Hillcrest Hospital, Nursing Institute, Mayfield Heights, OH.
| | - Isaac Briskin
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - James F Bena
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, OH
| | - Nancy M Albert
- Cleveland Clinic, Nursing Research and Innovation, Cleveland, OH
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25
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Morley G, Copley DJ, Field R, Zelinsky M, Albert NM. RESPONDER: A Qualitative Study of Ethical Issues Faced by Critical Care Nurses during the COVID-19 Pandemic. J Nurs Manag 2022; 30:2403-2415. [PMID: 36064194 PMCID: PMC9537935 DOI: 10.1111/jonm.13792] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/26/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
Abstract
AIMS To identify and understand ethical challenges arising during COVID-19 in intensive care; nurses' perceptions of how they made 'good' decisions and provided 'good' care when faced with ethical challenges, and use of moral resilience. BACKGROUND Little is known about the ethical challenges that nurses faced during the COVID-19 pandemic and ways they responded. Design Qualitative, descriptive free-text surveys and semi-structured interviews, underpinned by appreciative inquiry. METHODS Nurses working in intensive care in one academic quaternary care center and three community hospitals in Midwest United States were invited to participate. In total, 49 participants completed free-text surveys and 7 participants completed interviews. Data were analyzed using content analysis. RESULTS Five themes captured ethical challenges: implementation of the visitation policy; patients dying alone; surrogate decision-making; diminished safety and quality of care; and imbalance and injustice between professionals. Four themes captured nurses' responses: personal strength and values, problem-solving, teamwork and peer support, and resources. CONCLUSIONS Ethical challenges were not novel but were amplified due to repeated occurrence and duration. Some nurses' demonstrated capacities for moral resilience, but none described drawing on all four capacities. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers would benefit from greater ethics training to support their nursing teams.
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Affiliation(s)
- Georgina Morley
- Center for Bioethics, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dianna Jo Copley
- Stanley S. Zielony Institute for Nursing Excellence; and Nursing Ethics Faculty Fellow, Center for Bioethics, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rosemary Field
- Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic Marymount Hospital, Ohio, USA
| | - Megan Zelinsky
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nancy M Albert
- Office of Nursing Research and Innovation, Stanley S. Zielony Institute for Nursing Excellence, Cleveland Clinic Health System, Cleveland, OH, USA
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Prasun MA, Blakeman JR, Vuckovic KM, Stamp KD, Albert NM. Nurses’ Personal Perceptions of Clinical Work Adaptation During COVID-19. Heart Lung 2022; 56:175-180. [PMID: 35961084 PMCID: PMC9340054 DOI: 10.1016/j.hrtlng.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022]
Abstract
Background Objective Methods Results Conclusion
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Affiliation(s)
- Marilyn A Prasun
- Illinois State University, Mennonite College of Nursing, 111B Edwards Hall, Campus Box 5810, Normal, Illinois, United States.
| | - John R Blakeman
- Illinois State University, Mennonite College of Nursing, Normal, Illinois, United States
| | - Karen M Vuckovic
- University of Illinois Chicago, College of Nursing, Chicago, Illinois, United States
| | - Kelly D Stamp
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado, United States
| | - Nancy M Albert
- Office of Nursing Research and Innovation, Cleveland Clinic Health System, Clinical Nurse Specialist - Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular & Thoracic Institute, Clinic Main Campus, Cleveland, United States
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27
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Rao VN, Kaltenbach LA, Granger BB, Fonarow GC, Al-Khalidi HR, Albert NM, Butler J, Allen LA, Lanfear DE, Ariely D, Miller JM, Brodsky MA, LaLonde TA, Lafferty JC, Granger CB, Hernandez AF, DeVore AD. The Association of Digital Health Application Use with Heart Failure Care and Outcomes: Insights from CONNECT-HF. J Card Fail 2022; 28:1487-1496. [PMID: 35905867 DOI: 10.1016/j.cardfail.2022.07.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unknown if digital applications may improve guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS CONNECT-HF included an optional, prospective ancillary study of a mobile health application among hospitalized patients for HFrEF. Digital users were matched to nonusers from the usual care group. Co-primary outcomes included change in opportunity-based composite HF quality scores and HF rehospitalization or all-cause mortality. Among 2,431 patients offered digital applications across the United States, 1,526 (63%) had limited digital access or insufficient data, 425 (17%) were digital users, and 480 (20%) declined use. Digital users were similar in age to those who declined use (mean 58 vs. 60 years, p=0.031). Digital users (N=368) versus matched nonusers (N=368) had improved composite HF quality scores (48.0% vs. 43.6%; +4.76% [3.27-6.24]; p=0.001) and composite clinical outcomes (33.0% vs. 39.6%; HR 0.76 [0.59-0.97]; p=0.027). CONCLUSIONS Among participants in CONNECT-HF, use of digital applications was modest, yet associated with higher HF quality of care scores, including use of GDMT, and better clinical outcomes. While cause and effect cannot be determined from this study, the application of technology to guide GDMT use and dosing among patients with HFrEF warrants further investigation.
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Affiliation(s)
- Vishal N Rao
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Lisa A Kaltenbach
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Hussein R Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Larry A Allen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - David E Lanfear
- Department of Medicine, Cardiovascular Division, and Henry Ford Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI
| | - Dan Ariely
- Center for Advanced Hindsight, Duke University, Durham, NC
| | - Julie M Miller
- Center for Advanced Hindsight, Duke University, Durham, NC
| | | | - Thomas A LaLonde
- Division of Cardiology, Department of Medicine, Ascension St. John Hospital, Detroit, MI
| | - James C Lafferty
- Department of Cardiology, Staten Island University Hospital-Northwell Health, Staten Island, NY
| | - Christopher B Granger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Adam D DeVore
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC.
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Chapman B, Hellkamp AS, Thomas LE, Albert NM, Butler J, Patterson JH, Hernandez AF, Williams FB, Shen X, Spertus JA, Fonarow GC, DeVore AD. Angiotensin Receptor Neprilysin Inhibition and Associated Outcomes by Race and Ethnicity in Patients With Heart Failure With Reduced Ejection Fraction: Data From CHAMP-HF. J Am Heart Assoc 2022; 11:e022889. [PMID: 35722989 PMCID: PMC9238653 DOI: 10.1161/jaha.121.022889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/29/2022] [Indexed: 12/11/2022]
Abstract
Background There are limited data on the use of angiotensin receptor neprilysin inhibitors (ARNIs) in minority populations with heart failure (HF) with reduced ejection fraction. We used data from the CHAMP-HF (Change the Management of Patients With Heart Failure) registry to evaluate ARNI initiation and associated changes in health status and clinical outcomes across different races and ethnicities. Methods and Results CHAMP-HF was a prospective, observational registry of US outpatients with chronic HF with reduced ejection fraction. We compared patients starting ARNI with patients not starting ARNI using a propensity-matched analysis. Patients were grouped as Hispanic, non-Hispanic Black, non-Hispanic White, or non-Hispanic other individuals, where "non-Hispanic other" consists of all patients who did not identify as Hispanic, Black, or White. Health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire. Outcomes were analyzed with multivariable models that included race and ethnicity, ARNI initiation, and an interaction term between race and ethnicity and ARNI initiation. Cox proportional hazards models were used for death/HF hospitalization, and multiple regression was used for change in Kansas City Cardiomyopathy Questionnaire score. The analysis included 1516 patients, with 758 patients in each group (ARNI and no ARNI). Changes in Kansas City Cardiomyopathy Questionnaire score after ARNI initiation were similar among all race and ethnicity groups (mean [SD], non-Hispanic White individuals, 3.5 [19.0]; non-Hispanic Black individuals, 2.0 [17.0]; non-Hispanic other individuals, 5.5 [20.3]; and Hispanic individuals, 3.2 [20.1]), with no statistically significant interaction between race and ethnicity and ARNI initiation (P=0.21). There was similarly no statistically significant interaction between race and ethnicity and ARNI initiation for HF hospitalization (P=0.82) or all-cause mortality (P=0.92). Conclusions In a large registry of outpatients with HF with reduced ejection fraction, the association between ARNI initiation and outcomes did not differ by race and ethnicity. These data support the use of ARNI therapy for chronic HF with reduced ejection fraction irrespective of race and ethnicity.
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Affiliation(s)
- Brittany Chapman
- Department of MedicineDuke University School of MedicineDurhamNC
| | | | | | | | - Javed Butler
- University of Mississippi Medical CenterJacksonMS
| | | | - Adrian F. Hernandez
- Department of MedicineDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDurhamNC
| | | | - Xian Shen
- Novartis Pharmaceuticals CorporationEast HanoverNJ
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute and the University of Missouri–Kansas CityKansas CityMO
| | - Gregg C. Fonarow
- Ahmanson‐UCLA Cardiomyopathy CenterRonald Reagan UCLA Medical CenterLos AngelesCA
| | - Adam D. DeVore
- Department of MedicineDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDurhamNC
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Nowlin J, Will B, Miller B, Bena JF, Morrison SM, Albert NM. Distractions when viewing in-hospital heart failure self-care videos and change in heart failure self-care knowledge. Heart Lung 2022; 53:67-71. [DOI: 10.1016/j.hrtlng.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/24/2022] [Accepted: 02/02/2022] [Indexed: 11/04/2022]
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Albert NM, Bena JF, Morrison SL, Williams JB, Faulkenberg K, Levay M, Shen X. Abstract 34: 12-month Clinical Outcomes Among Patients With Heart Failure And Reduced To Preserved Ejection Fraction Based On Sacubitril/valsartan Versus Angiotensin Converting Enzyme Inhibitor Or Angiotensin Receptor Blocker Use - A Retrospective, Parallel, Multi-group Study. Circ Cardiovasc Qual Outcomes 2022. [DOI: 10.1161/circoutcomes.15.suppl_1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Real-world 12-month outcomes of sacubitril/valsartan (sac/val) vs. ACEi or ARB use among patients with HFrEF (EF < 40%) through HFpEF (HFmrEF EF 40-49% and HFpEF EF 50-60%) are not well known. A better understanding of hospitalization (hosp), emergency department (ED) visits and mortality provides new information about medication benefits in patients with HF and a wide range of ejection fractions (EF).
Methods:
Data were retrieved from a multi-state healthcare system database. Patients prescribed sac/val from Aug. 1 2015-Jul. 31 2018 were matched to those on ACEi or ARB based on age, sex, EF, comorbidity status, hospital vs. ambulatory index date reflecting medication use and systolic
blood pressure. Twelve-month outcomes based on sac/val vs. ACEi or ARB were assessed using linear, logistic, and Poisson models with generalized estimating equations.
Results:
Of 3588 patients (1794 per group), mean (SD) age was 64.2 (13.0) years, 70.3% were male, 20.7% were Black, and mean systolic blood pressure was 122.1 (16.1) mmHg. By HF factors, 47.6% were NYHA-FC II and mean EF% was 29.0 (9.9); 349 (9.7%) had HFmrEF or HFpEF. At baseline, 92.4% were on beta-blockers, 43% were on aldosterone antagonists and 63.1% were on loop diuretics. Over 12 months, 125 patients died (38 sac/val vs. 87 ACEi or ARB; p <0.001). Sac/val use was associated with fewer 12-month all-cause and HF hosp, HF ED visits and the composite outcome (all p <0.001); see Figure of adjusted event rate (%) odds ratios.
Conclusions:
Among patients with HFrEF, HFmrEF and HFpEF (EF up to 60%), use of sac/val was associated with fewer 12-month death and morbidity (all-cause and HF hosp and HF-related ED visits). Patient and provider factors that facilitated sac/val use and improved clinical outcomes should be studied.
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Affiliation(s)
| | | | | | | | | | | | - Xian Shen
- NOVARTIS PHARMACEUTICAL CORPORATION, East Hanover, NJ
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Granger BB, Kaltenbach LA, Fonarow GC, Allen LA, Lanfear DE, Albert NM, Al-Khalidi HR, Butler J, Cooper LB, DeWald T, Felker GM, Heidenreich P, Kottam A, Lewis EF, Piña IL, Yancy CW, Granger CB, Hernandez AF, DeVore AD. Health System-Level Performance in Prescribing Guideline-Directed Medical Therapy for Patients with HFrEF: Results from the CONNECT-HF Trial. J Card Fail 2022; 28:1355-1361. [PMID: 35462033 DOI: 10.1016/j.cardfail.2022.03.356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/10/2022] [Accepted: 03/25/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Health system-level interventions to improve use of guideline-directed medical therapy (GDMT) often fail in the acute care setting. We sought to identify factors associated with high performance in adoption of GDMT among health systems in CONNECT-HF. METHODS AND RESULTS Site-level composite quality scores were calculated at discharge and last follow-up. Site performance was defined as the average change in score from baseline to last follow-up and analyzed by performance tertile using a mixed-effects model with baseline performance as a fixed effect and site as a random effect. Among 150 randomized sites, mean 12-month improvement in GDMT was 1.8% (-26.4% to 60.0%). Achievement of ≥50% target dose for angiotensin-converting enzymes/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors and beta blockers at 12 months was modest, even at the highest performing sites (median 29.6% [23%, 41%] and 41.2% [29%, 50%]). Sites achieving higher GDMT scores had care teams that included social workers and pharmacists and patients able to afford medications and access medication lists in the electronic health record. CONCLUSIONS Substantial gaps in site-level use of GDMT were found even among highest performing sites. Failure of hospital-level interventions to improve quality metrics suggests that a team-based approach to care and improved patient access to medications are needed for post-discharge success.
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Affiliation(s)
- Bradi B Granger
- Duke Clinical Research Institute; Duke University School of Nursing; Duke University School of Medicine, Durham, NC, USA.
| | | | | | - Larry A Allen
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Tracy DeWald
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - G Michael Felker
- Duke Clinical Research Institute; Duke University School of Medicine, Durham, NC, USA
| | | | - Anupama Kottam
- Wayne State University and Detroit Medical Center, Detroit, MI, USA
| | | | - Ileana L Piña
- Wayne State University and Detroit Medical Center, Detroit, MI, USA
| | | | - Christopher B Granger
- Duke Clinical Research Institute; Duke University School of Medicine, Durham, NC, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute; Duke University School of Medicine, Durham, NC, USA
| | - Adam D DeVore
- Duke Clinical Research Institute; Duke University School of Medicine, Durham, NC, USA
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Hernandez AF, Albert NM, Allen LA, Ahmed R, Averina V, Boehmer JP, Cowie MR, Chien CV, Galvao M, Klein L, Kwan B, Lam CSP, Ruble SB, Stolen CM, Stein K. Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) - Phase I Evaluation of the Integration and Safety of the HeartLogic Multisensor Algorithm in Patients With Heart Failure. J Card Fail 2022; 28:1245-1254. [PMID: 35460884 DOI: 10.1016/j.cardfail.2022.03.349] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with heart failure and reduced ejection fraction (HFrEF) suffer from a relapsing and remitting disease, where early treatment changes may improve outcomes. We assessed the clinical integration and safety of the HeartLogic multi-sensor index and alerts in heart failure care. METHODS The Multiple cArdiac seNsors for mAnaGEment of Heart Failure (MANAGE-HF) study enrolled 200 patients with HFrEF (< 35%), NYHA class II-III symptoms, implanted with a CRT-D or ICD, who had either a hospitalization for HF within 12 months or unscheduled visit for HF exacerbation within 90 days or an elevated natriuretic peptide concentration (BNP≥150 pg/mL or NT-proBNP≥600 pg/mL). This phase included development of an alert management guide and evaluated changes in medical treatment, natriuretic peptide levels, and safety. RESULTS Mean age of participants was 67 years, 68% were men, 81% were white, and 61% had a HF hospitalization in prior 12 months. During follow-up there were 585 alert cases with an average of 1.76 alert cases/pt-yr. HF medications were augmented during 74% of the alert cases. HF treatment augmentation within 2 weeks from an initial alert was associated with more rapid recovery of the HeartLogic Index. Five SAEs (0.015 per pt-year) occurred in relation to alert-prompted medication change. NTproBNP levels decreased from median of 1316 pg/mL at baseline to 743 pg/mL at 12 months (p<0.001). CONCLUSIONS HeartLogic alert management was safely implemented in HF care and may optimize HF management. This phase supports further evaluation in larger studies. TRIAL REGISTRATION ClinicalTrials.gov (NCT03237858).
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Affiliation(s)
- Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
| | - Nancy M Albert
- Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | | | - John P Boehmer
- Division of Cardiology, Department of Medicine Penn State University College of Medicine, Hershey, Pennsylvania
| | - Martin R Cowie
- Royal Brompton Hospital & Faculty of Lifesciences & Medicine, King's College London, London, United Kingdom
| | - Christopher V Chien
- Division of Cardiology, Department of Medicine University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Marie Galvao
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Liviu Klein
- Division of Cardiology, Department of Medicine, UC San Francisco, San Francisco, CA
| | | | - Carolyn S P Lam
- National Heart Centre Singapore & Duke National University of Singapore, Singapore
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Mohammed M, Hill CL, Thomas L, Nassif M, DeVore AD, Albert NM, Butler J, Patterson JH, Williams FB, Hernandez A, Fonarow GC, Spertus JA. Poor Medication Adherence Is Associated With Worse Health Status In Heart Failure With Reduced Ejection Fraction. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Albert NM, Bena JF, Morrison SL, Williams JB, Faulkenberg K, Levay M, Shen X. Clinical Outcomes When Utilizing Sacubitril-Valsartan Vs. ACEi/ARB In Patients With HF And Ejection Fractions Spanning From Reduced To Preserved - A Retrospective, Parallel, Multi-Group Study. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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DeVore AD, Hellkamp AS, Thomas L, Albert NM, Butler J, Patterson JH, Spertus JA, Williams FB, Shen X, Hernandez AF, Fonarow GC. The Association of Improvement in Left Ventricular Ejection Fraction with Outcomes in Patients with Heart Failure with Reduced Ejection Fraction: Data from CHAMP-HF. Eur J Heart Fail 2022; 24:762-770. [PMID: 35293088 DOI: 10.1002/ejhf.2486] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/07/2022] Open
Abstract
AIMS We assessed for an association between improvements in left ventricular ejection fraction (LVEF) and future outcomes, including health status, in routine clinical practice. METHODS AND RESULTS CHAMP-HF was a registry of outpatients with heart failure (HF) and LVEF <40%. Enrolled participants completed the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) at regular intervals and were followed as part of routine care. We assessed for associations between improvements in LVEF (>10%) over time and concurrent changes in KCCQ-12, as well as the subsequent risk of poor outcomes. We included 2092 participants in the study. They had the following characteristics: median age 67 years (25th , 75th percentile 58, 75), 29% female, median duration of HF 2.7 years (0.6, 6.8), and median baseline LVEF 30% (23, 35). Of the study participants, 689 (34%) had a >10% absolute improvement in LVEF. Participants with an LVEF improvement also had an improvement in KCCQ-12 overall summary score compared with participants without an LVEF improvement (+7.6 vs +3.5, adjusted effect estimate +4.1 [95% CI 2.3 to 5.7]). Similarly, subsequent all-cause death or HF hospitalization occurred in 12% in the LVEF improvement group vs 25% in the group without an LVEF improvement (adjusted HR 0.50, 95% CI 0.41 to 0.61). CONCLUSION In a large cohort of outpatients with chronic HF, improvements in LVEF were associated with improved health status and a reduced risk for future clinical events. These data underscore the importance of improvement in LVEF as a treatment target for medical interventions for patients with chronic HF.
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Affiliation(s)
- Adam D DeVore
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Laine Thomas
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - Xian Shen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
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Ding Q, Spatz ES, Isaacs D, Bena J, Morrison S, Levay M, West L, Combs P, Albert NM. CARDIOVASCULAR DISEASE AND TYPE 2 DIABETES: TREATMENT SATISFACTION, QUALITY OF LIFE AND DIABETES RELATED SYMPTOMS WHEN RECEIVING SODIUM GLUCOSE COTRANSPORTER 2 INHIBITOR VERSUS OTHER NONINULIN DIABETES MEDICATIONS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02538-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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DeVore AD, Hill CL, Thomas LE, Albert NM, Butler J, Patterson JH, Hernandez AF, Williams FB, Shen X, Spertus JA, Fonarow GC. Identifying patients at increased risk for poor outcomes from heart failure with reduced ejection fraction: the PROMPT-HF risk model. ESC Heart Fail 2021; 9:178-185. [PMID: 34791838 PMCID: PMC8787961 DOI: 10.1002/ehf2.13709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/04/2021] [Accepted: 10/29/2021] [Indexed: 01/14/2023] Open
Abstract
Aims We aimed to develop a risk prediction tool that incorporated both clinical events and worsening health status for patients with heart failure (HF) with reduced ejection fraction (HFrEF). Identifying patients with HFrEF at increased risk of a poor outcome may enable proactive interventions that improve outcomes. Methods and results We used data from a longitudinal HF registry, CHAMP‐HF, to develop a risk prediction tool for poor outcomes over the next 6 months. A poor outcome was defined as death, an HF hospitalization, or a ≥20‐point decrease (or decrease below 25) in 12‐item Kansas City Cardiomyopathy Questionnaire (KCCQ‐12) overall summary score. Among 4546 patients in CHAMP‐HF, 1066 (23%) experienced a poor outcome within 6 months (1.3% death, 11% HF hospitalization, and 11% change in KCCQ‐12). The model demonstrated moderate discrimination (c‐index = 0.65) and excellent calibration with observed data. The following variables were associated with a poor outcome: age, race, education, New York Heart Association class, baseline KCCQ‐12, atrial fibrillation, coronary disease, diabetes, chronic kidney disease, smoking, prior HF hospitalization, and systolic blood pressure. We also created a simplified model with a 0–10 score using six variables (New York Heart Association class, KCCQ‐12, coronary disease, chronic kidney disease, prior HF hospitalization, and systolic blood pressure) with similar discrimination (c‐index = 0.63). Patients scoring 0–3 were considered low risk (event rate <20%), 4–6 were considered intermediate risk (event rate 20–40%), and 7–10 were considered high risk (event rate >40%). Conclusions The PROMPT‐HF risk model can identify outpatients with HFrEF at increased risk of poor outcomes, including clinical events and health status deterioration. With further validation, this model may help inform therapeutic decision making.
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Affiliation(s)
- Adam D DeVore
- Duke Clinical Research Institute, 200 Morris Street, Office 6318, Durham, NC, 27701, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Claude Larry Hill
- Duke Clinical Research Institute, 200 Morris Street, Office 6318, Durham, NC, 27701, USA
| | - Laine E Thomas
- Duke Clinical Research Institute, 200 Morris Street, Office 6318, Durham, NC, 27701, USA
| | | | - Javed Butler
- University of Mississippi Medical Center, Jackson, MS, USA
| | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, 200 Morris Street, Office 6318, Durham, NC, 27701, USA.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Xian Shen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
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Khan MS, Greene SJ, Hellkamp AS, DeVore AD, Shen X, Albert NM, Patterson JH, Spertus JA, Thomas LE, Williams FB, Hernandez AF, Fonarow GC, Butler J. Diuretic Changes, Health Care Resource Utilization, and Clinical Outcomes for Heart Failure With Reduced Ejection Fraction: From the Change the Management of Patients With Heart Failure Registry. Circ Heart Fail 2021; 14:e008351. [PMID: 34674536 DOI: 10.1161/circheartfailure.121.008351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diuretics are a mainstay therapy for the symptomatic treatment of heart failure. However, in contemporary US outpatient practice, the degree to which diuretic dosing changes over time and the associations with clinical outcomes and health care resource utilization are unknown. METHODS Among 3426 US outpatients with chronic heart failure with reduced ejection fraction in the Change the Management of Patients with Heart Failure registry with complete medication data and who were prescribed a loop diuretic, diuretic dose increase was defined as: (1) change to a total daily dose higher than their previous total daily dose, (2) addition of metolazone to the regimen, (3) change from furosemide to either bumetanide or torsemide, and the change persists for at least 7 days. Adjusted hazard ratios or rate ratios along with 95% CIs were reported for clinical outcomes among patients with an increase in oral diuretic dose versus no increase in diuretic dose. RESULTS Overall, 796 (23%) had a diuretic dose increase (18 episodes per 100 patient-years). The proportion of patients with dyspnea at rest (38% versus 26%), dyspnea at exertion (79% versus 67%), orthopnea (32% versus 21%), edema (60% versus 43%), and weight gain (40% versus 23%) were significantly (all P <0.001) higher in the diuretic increase group. Baseline angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (hazard ratio, 0.75 [95% CI, 0.65-0.87]) use were associated with lower likelihood of diuretic increase over time. Patients with a diuretic dose increase had a significantly higher number of heart failure hospitalizations (rate ratio, 2.53 [95% CI, 2.10-3.05]), emergency department visits (rate ratio, 1.84 [95% CI, 1.56-2.17]), and home health visits (rate ratio, 1.88 [95% CI, 1.39-2.54]), but not all-cause mortality (hazard ratio, 1.10 [95% CI, 0.89-1.36]). Similarly, greater furosemide dose equivalent increases were associated with greater resource utilization but not with mortality, compared with smaller increases. CONCLUSIONS In this contemporary US registry, 1 in 4 patients with heart failure with reduced ejection fraction had outpatient escalation of diuretic therapy over longitudinal follow-up, and these patients were more likely to have sign/symptoms of congestion. Outpatient diuretic dose escalation of any magnitude was associated with heart failure hospitalizations and resource utilization, but not all-cause mortality.
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Affiliation(s)
| | - Stephen J Greene
- Duke Clinical Research Institute, Durham, NC (S.J.G., A.S.H., A.D.D., L.E.T., A.F.H.)
| | - Anne S Hellkamp
- Duke Clinical Research Institute, Durham, NC (S.J.G., A.S.H., A.D.D., L.E.T., A.F.H.).,Department of Biostatistics and Bioinformatics (A.S.H., L.E.T.), Duke University School of Medicine, Durham, NC
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, NC (S.J.G., A.S.H., A.D.D., L.E.T., A.F.H.)
| | - Xian Shen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ (X.S.)
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, OH (N.M.A.)
| | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill (J.H.P.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City (J.A.S.)
| | - Laine E Thomas
- Duke Clinical Research Institute, Durham, NC (S.J.G., A.S.H., A.D.D., L.E.T., A.F.H.).,Department of Biostatistics and Bioinformatics (A.S.H., L.E.T.), Duke University School of Medicine, Durham, NC
| | | | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC (S.J.G., A.S.H., A.D.D., L.E.T., A.F.H.)
| | - Gregg C Fonarow
- Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.)
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson (J.B.)
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Morris AA, Khazanie P, Drazner MH, Albert NM, Breathett K, Cooper LB, Eisen HJ, O'Gara P, Russell SD. Guidance for Timely and Appropriate Referral of Patients With Advanced Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e238-e250. [PMID: 34503343 DOI: 10.1161/cir.0000000000001016] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Among the estimated 6.2 million Americans living with heart failure (HF), ≈5%/y may progress to advanced, or stage D, disease. Advanced HF has a high morbidity and mortality, such that early recognition of this condition is important to optimize care. Delayed referral or lack of referral in patients who are likely to derive benefit from an advanced HF evaluation can have important adverse consequences for patients and their families. A 2-step process can be used by practitioners when considering referral of a patient with advanced HF for consideration of advanced therapies, focused on recognizing the clinical clues associated with stage D HF and assessing potential benefits of referral to an advanced HF center. Although patients are often referred to an advanced HF center to undergo evaluation for advanced therapies such as heart transplantation or implantation of a left ventricular assist device, there are other reasons to refer, including access to the infrastructure and multidisciplinary team of the advanced HF center that offers a broad range of expertise. The intent of this statement is to provide a framework for practitioners and health systems to help identify and refer patients with HF who are most likely to derive benefit from referral to an advanced HF center.
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Greene SJ, Butler J, Hellkamp AS, Spertus JA, Vaduganathan M, Devore AD, Albert NM, Patterson JH, Thomas L, Williams FB, Hernandez AF, Fonarow GC. Comparative Effectiveness of Dosing of Medical Therapy for Heart Failure: From the CHAMP-HF Registry. J Card Fail 2021; 28:370-384. [PMID: 34793971 DOI: 10.1016/j.cardfail.2021.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/30/2021] [Accepted: 08/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The comparative effectiveness of differing doses of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) on clinical and patient-reported outcomes in US clinical practice is unknown. This study sought to characterize associations between dosing of GDMT and outcomes for patients with HFrEF in U.S. clinical practice METHODS: : This analysis included 4,832 US outpatients with chronic HFrEF across 150 practices in the CHAMP-HF registry with no contraindication and available dosing data for at least 1 GDMT at baseline. Baseline dosing of angiotensin-converting enzyme (ACEI)/ angiotensin II receptor blocker (ARB)/ angiotensin receptor-neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA) therapies were examined. For each medication class, multivariable models assessed associations between medication dosing and clinical outcomes over 24 months (all-cause mortality, HF hospitalization) and patient-reported outcomes at 12 months (change in Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS]). RESULTS After adjustment, compared with target dosing, lower dosing was associated with higher all-cause mortality for ACEI/ARB/ARNI (50% to <100% target dose, HR 1.16 [95% CI 0.87-1.55]; <50% target dose, HR 1.37 [95% CI 1.05-1.79]; none, HR 1.75 [95% CI 1.32-2.34; overall p<0.001) and beta-blocker (50% to <100% target dose, HR 1.30 [95% CI 1.00-1.69]; <50% target dose, HR 1.41 [95% CI 1.11-1.79; none, HR 1.24 [95% CI 0.92-1.67]; overall p=0.042). Lower dosing of ACEI/ARB/ARNI was independently associated with higher risk of HF hospitalization (50% to <100% target dose, HR 1.08 [95% CI 0.90-1.30]; <50% target dose, HR 1.23 [1.04-1.47]; none, HR 1.29 [1.04-1.60]; overall p=0.046), but beta-blocker dosing was not (overall p=0.085). Target dosing of MRA was not associated with risk of mortality or HF hospitalization. For each GDMT, compared with target dosing, lower dosing was not associated with change in KCCQ-OS at 12 months, with potential exception of worsening KCCQ-OS with lower dosing of ACEI/ARB/ARNI. CONCLUSIONS In this contemporary US outpatient HFrEF registry, target dosing of ACEI/ARB/ARNI and beta-blocker therapy was associated with reduced mortality, and variably associated with HF hospitalization and patient-reported outcomes. MRA dosing was not associated with outcomes. The totality of these findings support the benefits of target dosing of GDMT in routine practice, as tolerated, with unmeasured differences between patients receiving differing dosages potentially explaining differing results seen here compared with randomized clinical trials.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Missouri
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Adam D Devore
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Laine Thomas
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, California.
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Tran AT, Fonarow GC, Arnold SV, Jones PG, Thomas LE, Hill CL, DeVore AD, Butler J, Albert NM, Spertus JA. Risk Adjustment Model for Preserved Health Status in Patients With Heart Failure and Reduced Ejection Fraction: The CHAMP-HF Registry. Circ Cardiovasc Qual Outcomes 2021; 14:e008072. [PMID: 34615366 DOI: 10.1161/circoutcomes.121.008072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Health status outcomes are increasingly being promoted as measures of health care quality, given their importance to patients. In heart failure (HF), an American College of Cardiology/American Heart Association Task Force proposed using the proportion of patients with preserved health status as a quality measure but not as a performance measure because risk adjustment methods were not available. METHODS We built risk adjustment models for alive with preserved health status and for preserved health status alone in a prospective registry of outpatients with HF with reduced ejection fraction across 146 US centers between December 2015 and October 2017. Preserved health status was defined as not having a ≥5-point decrease in the Kansas City Cardiomyopathy Questionnaire Overall Summary score at 1 year. Using only patient-level characteristics, hierarchical multivariable logistic regression models were developed for 1-year outcomes and validated using data from 1 to 2 years. We examined model calibration, discrimination, and variability in sites' unadjusted and adjusted rates. RESULTS Among 3932 participants (median age [interquartile range] 68 years [59-75], 29.7% female, 75.4% White), 2703 (68.7%) were alive with preserved health status, 902 (22.9%) were alive without preserved health status, and 327 (8.3%) had died by 1 year. The final risk adjustment model for alive with preserved health status included baseline Kansas City Cardiomyopathy Questionnaire Overall Summary, age, race, employment status, annual income, body mass index, depression, atrial fibrillation, renal function, number of hospitalizations in the past 1 year, and duration of HF (optimism-corrected C statistic=0.62 with excellent calibration). Similar results were observed when deaths were ignored. The risk standardized proportion of patients alive with preserved health status across the 146 sites ranged from 62% at the 10th percentile to 75% at the 90th percentile. Variability across sites was modest and changed minimally with risk adjustment. CONCLUSIONS Through leveraging data from a large, outpatient, observational registry, we identified key factors to risk adjust sites' proportions of patients with preserved health status. These data lay the foundation for building quality measures that quantify treatment outcomes from patients' perspectives.
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Affiliation(s)
- Andy T Tran
- Saint Luke's Mid America Heart Institute, Kansas City, MO (A.T.T., S.V.A., P.G.J., J.A.S.).,University of Missouri-Kansas City (A.T.T., S.V.A., P.G.J., J.A.S.)
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center (G.C.F.)
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, MO (A.T.T., S.V.A., P.G.J., J.A.S.).,University of Missouri-Kansas City (A.T.T., S.V.A., P.G.J., J.A.S.)
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, MO (A.T.T., S.V.A., P.G.J., J.A.S.).,University of Missouri-Kansas City (A.T.T., S.V.A., P.G.J., J.A.S.)
| | - Laine E Thomas
- Duke Clinical Research Institute, Durham, NC (L.E.T., C.L.H., A.D.D.)
| | - C Larry Hill
- Duke Clinical Research Institute, Durham, NC (L.E.T., C.L.H., A.D.D.)
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, NC (L.E.T., C.L.H., A.D.D.).,Department of Medicine, Duke University School of Medicine, Durham, NC (A.D.D.)
| | - Javed Butler
- University of Mississippi Medical Center, Jackson (J.B.)
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure-Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (N.M.A.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO (A.T.T., S.V.A., P.G.J., J.A.S.).,University of Missouri-Kansas City (A.T.T., S.V.A., P.G.J., J.A.S.)
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Bhatt AS, Adler ED, Albert NM, Anyanwu A, Bhadelia N, Cooper LT, Correa A, Defilippis EM, Joyce E, Sauer AJ, Solomon SD, Vardeny O, Yancy C, Lala A. Coronavirus Disease-2019 and Heart Failure: A Scientific Statement From the Heart Failure Society of America. J Card Fail 2021; 28:93-112. [PMID: 34481067 PMCID: PMC8408888 DOI: 10.1016/j.cardfail.2021.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Ankeet S Bhatt
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric D Adler
- Department of Cardiology, University of California, San Diego, California
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute; Cleveland Clinic, Cleveland, Ohio
| | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nahid Bhadelia
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts; Center for Emerging Infectious Diseases Policy and Research (CEID), Boston University, Boston, Massachusetts
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Ashish Correa
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ersilia M Defilippis
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Emer Joyce
- Department of Cardiovascular Medicine, Mater University Hospital, and School of Medicine, University College Dublin, Ireland
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, Kansas
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Orly Vardeny
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, and University of Minnesota, Minneapolis
| | - Clyde Yancy
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Vaduganathan M, Fonarow GC, Greene SJ, Devore AD, Albert NM, Duffy CI, Hill CL, Patterson JH, Spertus JA, Thomas LE, Williams FB, Hernandez AF, Butler J. Treatment Persistence of Renin-Angiotensin-Aldosterone-System Inhibitors Over Time in Heart Failure with Reduced Ejection Fraction. J Card Fail 2021; 28:191-201. [PMID: 34428591 DOI: 10.1016/j.cardfail.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Clinical practice guidelines support sustained use of renin-angiotensin-aldosterone-system (RAAS) inhibitors over time in heart failure with reduced ejection fraction, yet few data are available regarding the frequency, timing or predictors of early treatment discontinuation in clinical practice. METHODS Among prevalent or new users of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), and mineralocorticoid receptor antagonists (MRAs) in the CHAMP-HF (Change the Management of Patients with Heart Failure) registry, we estimated the frequency and independent predictors of treatment discontinuation during follow-up. Among sites with > 5 users of a given RAAS inhibitor, we evaluated practice variation in the proportion of patients with treatment discontinuation. RESULTS Over median follow-up of 18 months, frequency of drug discontinuation of ACEis/ARBs, ARNIs and MRAs was 12.7% (444 of 3509 users), 10.4% (140 of 1352 users), and 20.4% (435 of 2129 users), respectively. An additional, 149 (11.0%) of ARNI users were switched to ACEis/ARBs, and 447 (12.7%) of ACEi/ARB users were switched to ARNIs during follow-up. Across sites, the median proportion of discontinuation of ACEis/ARBs, ARNIs and MRAs was 12.5% (25th-75th percentiles 6.9%-18.9%), 18.8% (25th-75th percentiles 12.5%-28.6%), and 19.6% (25th-75th percentiles 10.7%-27.0%), respectively. Chronic kidney disease was the only independent predictor of increased risk of discontinuation of each of the RAAS inhibitor classes (P < 0.02 for all). Higher Kansas City Cardiomyopathy Questionnaire overall summary scores independently predicted lower risk of discontinuation of ACEis/ARBs and ARNIs (both P < 0.001) but not of MRAs. Investigator clinical experience was predictive of lower risks of discontinuation of ACEis/ARBs and MRAs (P < 0.02) but not of ARNIs. All other independent predictors of discontinuation were unique to individual therapeutic classes. CONCLUSIONS One in 10 patients discontinue ACEis/ARBs or ARNIs, and 1 in 5 discontinue MRAs in routine clinical practice of heart failure with reduced ejection fraction. Unique patient-level and clinician/practice-level factors are associated with premature discontinuation of individual RAAS inhibitors, which may help to guide structured efforts to promote treatment persistence in clinical care.
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Affiliation(s)
- Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA.
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, CA
| | - Stephen J Greene
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Adam D Devore
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Nancy M Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH
| | - Carol I Duffy
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - C Larry Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - John A Spertus
- Saint Luke's Mid-America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO
| | - Laine E Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Adrian F Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
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DeVore AD, Granger BB, Fonarow GC, Al-Khalidi HR, Albert NM, Lewis EF, Butler J, Piña IL, Allen LA, Yancy CW, Cooper LB, Felker GM, Kaltenbach LA, McRae AT, Lanfear DE, Harrison RW, Disch M, Ariely D, Miller JM, Granger CB, Hernandez AF. Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial. JAMA 2021; 326:314-323. [PMID: 34313687 PMCID: PMC8317015 DOI: 10.1001/jama.2021.8844] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
IMPORTANCE Adoption of guideline-directed medical therapy for patients with heart failure is variable. Interventions to improve guideline-directed medical therapy have failed to consistently achieve target metrics, and limited data exist to inform efforts to improve heart failure quality of care. OBJECTIVE To evaluate the effect of a hospital and postdischarge quality improvement intervention compared with usual care on heart failure outcomes and care. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial was conducted at 161 US hospitals and included 5647 patients (2675 intervention vs 2972 usual care) followed up after a hospital discharge for acute heart failure with reduced ejection fraction (HFrEF). The trial was performed from 2017 to 2020, and the date of final follow-up was August 31, 2020. INTERVENTIONS Hospitals (n = 82) randomized to a hospital and postdischarge quality improvement intervention received regular education of clinicians by a trained group of heart failure and quality improvement experts and audit and feedback on heart failure process measures (eg, use of guideline-directed medical therapy for HFrEF) and outcomes. Hospitals (n = 79) randomized to usual care received access to a generalized heart failure education website. MAIN OUTCOMES AND MEASURES The coprimary outcomes were a composite of first heart failure rehospitalization or all-cause mortality and change in an opportunity-based composite score for heart failure quality (percentage of recommendations followed). RESULTS Among 5647 patients (mean age, 63 years; 33% women; 38% Black; 87% chronic heart failure; 49% recent heart failure hospitalization), vital status was known for 5636 (99.8%). Heart failure rehospitalization or all-cause mortality occurred in 38.6% in the intervention group vs 39.2% in usual care (adjusted hazard ratio, 0.92 [95% CI, 0.81 to 1.05). The baseline quality-of-care score was 42.1% vs 45.5%, respectively, and the change from baseline to follow-up was 2.3% vs -1.0% (difference, 3.3% [95% CI, -0.8% to 7.3%]), with no significant difference between the 2 groups in the odds of achieving a higher composite quality score at last follow-up (adjusted odds ratio, 1.06 [95% CI, 0.93 to 1.21]). CONCLUSIONS AND RELEVANCE Among patients with HFrEF in hospitals randomized to a hospital and postdischarge quality improvement intervention vs usual care, there was no significant difference in time to first heart failure rehospitalization or death, or in change in a composite heart failure quality-of-care score. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03035474.
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Affiliation(s)
- Adam D. DeVore
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, California
- Associate Section Editor, JAMA Cardiology
| | - Hussein R. Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Nancy M. Albert
- Nursing Institute and Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio
| | - Eldrin F. Lewis
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, California
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Ileana L. Piña
- Wayne State University and Detroit Medical Center, Detroit, Michigan
| | - Larry A. Allen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora
| | - Clyde W. Yancy
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lauren B. Cooper
- Department of Heart Failure and Transplantation, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - G. Michael Felker
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Lisa A. Kaltenbach
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - David E. Lanfear
- Henry Ford Heart and Vascular Institute, Department of Medicine, Cardiovascular Division, Henry Ford Hospital, Detroit, Michigan
| | - Robert W. Harrison
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Dan Ariely
- Center for Advanced Hindsight, Duke University, Durham, North Carolina
| | - Julie M. Miller
- Center for Advanced Hindsight, Duke University, Durham, North Carolina
| | - Christopher B. Granger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Albert NM. Heart Failure is Everywhere: Insuring Diversity in Care Across Gender, Age, Race and Ethnicities. J Card Fail 2021; 27:722-723. [PMID: 34088385 DOI: 10.1016/j.cardfail.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Albert NM. Universal Definition and Classification of Heart Failure: New Clarity Brings New Clinical Implications for Health Care Professionals and the Need for New Research. J Card Fail 2021; 27:744-746. [PMID: 33971290 DOI: 10.1016/j.cardfail.2021.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nancy M Albert
- Nursing Institute, George M. and Linda H. Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio.
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Albert NM, Tyson RJ, Hill CL, DeVore AD, Spertus JA, Duffy C, Butler J, Patterson JH, Hernandez AF, Williams FB, Thomas L, Fonarow GC. Variation in use and dosing escalation of renin angiotensin system, mineralocorticoid receptor antagonist, angiotensin receptor neprilysin inhibitor and beta-blocker therapies in heart failure and reduced ejection fraction: Association of comorbidities. Am Heart J 2021; 235:82-96. [PMID: 33497697 DOI: 10.1016/j.ahj.2021.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND In patients with heart failure and reduced ejection fraction (HFrEF), angiotensin converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), or angiotensin receptor neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonists (MRA), and beta-blockers (βB) are underutilized. It is unknown if patients with and without comorbidities have similar ACEi/ARB/ARNI, MRA, and βB prescription patterns. METHODS Baseline data from the CHAMP-HF (Change the Management of Patients with Heart Failure) registry were categorized by history of atrial fibrillation, asthma/chronic lung disease, obstructive sleep apnea, and depression. Using multivariate hierarchical logistic models, associations of ACEi/ARB/ARNI, MRA and βB medication use and dose by comorbidities were assessed after adjusting for patient characteristics. RESULTS Of 4,815 HFrEF patients from 152 CHAMP-HF sites, ACEi/ARB/ARNI use was lower in patients with more comorbidities, and generally, MRA use was low and βB use was high. In adjusted analyses, patients with HFrEF and comorbid obstructive sleep apnea, vs. without, were more likely to be prescribed ARNI (OR [95% CI]: 1.25 [1.00, 1.55]); P = .047 and MRA (1.31 [1.11, 1.55]); P = .002 and less likely to be prescribed ACEi (0.74 [0.63, 0.88]); P < .001. Patients with atrial fibrillation, vs. without, were less likely to receive ACEi/ARB (0.82 [0.71, 0.95]); P = .006 and any study medication (0.81 [0.67, 0.97]); P = .020. Comorbid lung disease and history of depression were not associated with HFrEF prescriptions. CONCLUSIONS Renin-angiotensin-aldosterone blockade therapy prescription and dose varied by comorbidity status, but βB therapy did not. In quality efforts, leaders need to consider use and dosing of prescriptions in light of prevalent comorbidities.
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Greene SJ, Butler J, Spertus JA, Hellkamp AS, Vaduganathan M, DeVore AD, Albert NM, Duffy CI, Patterson JH, Thomas L, Williams FB, Hernandez AF, Fonarow GC. Comparison of New York Heart Association Class and Patient-Reported Outcomes for Heart Failure With Reduced Ejection Fraction. JAMA Cardiol 2021; 6:522-531. [PMID: 33760037 DOI: 10.1001/jamacardio.2021.0372] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance It is unclear how New York Heart Association (NYHA) functional class compares with patient-reported outcomes among patients with heart failure (HF) in contemporary US clinical practice. Objective To characterize longitudinal changes and concordance between NYHA class and the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OS), and their associations with clinical outcomes. Design, Setting, and Participants This cohort study included 2872 US outpatients with chronic HF with reduced ejection fraction across 145 practices enrolled in the CHAMP-HF registry between December 2015 and October 2017. All patients had complete NYHA class and KCCQ-OS data at baseline and 12 months. Longitudinal changes and correlations between the 2 measure were examined. Multivariable models landmarked at 12 months evaluated associations between improvement in NYHA and KCCQ-OS from baseline to 12 months with clinical outcomes occurring from months 12 through 24. Statistical analyses were performed from March to August 2020. Exposure Change in health status, as defined by 12-month change in NYHA class or KCCQ-OS. Main Outcomes and Measures All-cause mortality, HF hospitalization, and mortality or HF hospitalization. Results In total, 2872 patients were included in this analysis (median [interquartile range] age, 68 [59-75] years; 872 [30.4%] were women; and 2156 [75.1%] were of White race). At baseline, 312 patients (10.9%) were NYHA class I, 1710 patients (59.5%) were class II, 804 patients (28.0%) were class III, and 46 patients (1.6%) were class IV. For KCCQ-OS, 1131 patients (39.4%) scored 75 to 100 (best health status), 967 patients (33.7%) scored 50 to 74, 612 patients (21.3%) scored 25 to 49, and 162 patients (5.6%) scored 0 to 24 (worst health status). At 12 months, 1002 patients (34.9%) had a change in NYHA class (599 [20.9%] with improvement; 403 [14.0%] with worsening) and 2158 patients (75.1%) had a change of 5 or more points in KCCQ-OS (1388 [48.3%] with improvement; 770 [26.8%] with worsening). The most common trajectory for NYHA class was no change (1870 [65.1%]), and the most common trajectory for KCCQ-OS was an improvement of at least 10 points (1047 [36.5%]). After adjustment, improvement in NYHA class was not associated with subsequent clinical outcomes, whereas an improvement of 5 or more points in KCCQ-OS was independently associated with decreased mortality (hazard ratio, 0.59; 95% CI, 0.44-0.80; P < .001) and mortality or HF hospitalization (hazard ratio, 0.73; 95% CI, 0.59-0.89; P = .002). Conclusions and Relevance Findings of this cohort study suggest that, in contemporary US clinical practice, compared with NYHA class, KCCQ-OS is more sensitive to clinically meaningful changes in health status over time. Changes in KCCQ-OS may have more prognostic value than changes in NYHA class.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, North Carolina.,Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City
| | | | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, North Carolina.,Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Nancy M Albert
- Nursing Institute and Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Carol I Duffy
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Laine Thomas
- Duke Clinical Research Institute, Durham, North Carolina.,Assistant Editor for Statistics, JAMA Cardiology
| | | | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, North Carolina.,Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.,Associate Editor, JAMA Cardiology
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, Los Angeles.,Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
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Knipper NP, DiCioccio HC, Albert NM. What a Catch: Safety Intervention to Reframe Newborn Falls and Drops. MCN Am J Matern Child Nurs 2021; 46:161-167. [PMID: 33587342 DOI: 10.1097/nmc.0000000000000708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Parental fatigue rates after childbirth are high and may be associated with newborn drops that cause injury. Newborn drops and near-misses are potentially underreported due to parental embarrassment, shame, fear of reprisal, or guilt. Although newborn drops are rare, the leaders of mother-baby units need to enhance transparency of risk to assure a culture of safety. PURPOSE To describe components and outcomes of the What A Catch program, aimed at preventing newborn drops and addressing near-misses. METHODS The What A Catch program was implemented in two hospital mother-baby units. The five components of the program included maintaining a respite nursery, using visual management, positively framing situational communication and actions after a near-miss, safe and appropriate staffing, and celebrating and transparently displaying program successes. Data were collected on near-miss event rates and caregivers and families provided postevent comments. RESULTS The perinatal team embraced the program at both sites. Of 9,578 live births over 1 year, 202 near-misses or good catches were documented. Program leaders revise display the board multiple times per week. CLINICAL IMPLICATIONS Replication of this program is needed to determine if all five components are necessary to optimize a culture of safety. Future research may determine the scope of risk factors associated with newborn drops and near-misses, so that anticipated risk factors can be mitigated.
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Thomas M, Khariton Y, Fonarow GC, Arnold SV, Hill L, Nassif ME, Chan PS, Butler J, Thomas L, DeVore AD, Hernandez AF, Albert NM, Patterson JH, Williams FB, Spertus JA. Association between sacubitril/valsartan initiation and real-world health status trajectories over 18 months in heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:2670-2678. [PMID: 33932120 PMCID: PMC8318450 DOI: 10.1002/ehf2.13298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/09/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
Aims Improving the health status (symptoms, function, and quality of life) of patients with heart failure with reduced ejection fraction (HFrEF) is a primary treatment goal. Angiotensin receptor neprilysin inhibitors (ARNI) improve short‐term health status in clinical practice, but the sustainability of these improvements is unknown. Methods and results In CHAMP‐HF, a multicentre observational study of outpatients with HFrEF, patients initiated on ARNI were propensity score matched 1:2 to patients not using ARNI with Cox regression modelling time to ARNI initiation, adjusted for sociodemographic and clinical variables, medical history, medications, and baseline Kansas City Cardiomyopathy Questionnaire (KCCQ) scores. Repeated measures models for the overall KCCQ score and each domain compared the health status trajectories of patients initiated on ARNI vs. not. Among 3930 participants, 746 (19.0%) began ARNI, of whom 576 were matched to 1152 non‐ARNI patients. Prior to matching, participants initiated on ARNI were younger, non‐Hispanic, had lower EFs, more commonly had a history of ventricular arrhythmia, were less likely to be taking an ACEI/ARB, and more likely to be treated with beta‐blockers and mineralocorticoid receptor antagonists. There were no differences after matching. In the matched cohort, participants initiated on ARNI experienced improved health status by 3 months that persisted through 12 months [KCCQ Overall Summary Score (OSS) = 73.4 vs. 70.8; P < 0.001], with the largest benefit observed in the KCCQ Quality of Life domain (68.7 vs. 64.7; P < 0.001). Similar health status benefits were noted through 18 months (KCCQ‐OSS = 73.9 vs. 71.3; P < 0.001). A responder analysis showed that 12 patients would need to be initiated on ARNI for one to experience at least a large improvement (≥10 points) in health status benefit at 12 months. Conclusions In outpatient practice, ARNI therapy was associated with improved health status by 3 months and continued to 18 months after initiating therapy.
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Affiliation(s)
- Merrill Thomas
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Yevgeniy Khariton
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Larry Hill
- Duke Clinical Research Institute, Durham, NC, USA
| | - Michael E Nassif
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA
| | | | - Laine Thomas
- Duke Clinical Research Institute, Durham, NC, USA
| | - Adam D DeVore
- Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - J Herbert Patterson
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | | | - John A Spertus
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA
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